Background:The health of the population is shaped by political, social and environmental conditions - referred to as contextual factors in this paper - which influence the risk of type 2 diabetes and other non-communicable diseases (NCD). The article provides an overview of selected indicators for this topic. Method:The indicators were developed based on a literature review and a multi-stage selection process, considering their relevance for the prevention of diabetes and other NCD as well as the availability of data. Available nationwide data were used for operationalisation. Results:Six indicators were agreed upon: tobacco control, the consumer price index, food taxation and prevention expenditure in the area of health policy measures, the at-risk-of-poverty rate in the area of employment and social affairs, and use of means of transport in the area of built and physical environment. The time trends for these indicators are integrated into the NCD Surveillance of the Robert Koch Institute (RKI) and are presented on the web portal of the federal health reporting. The results for all indicators point to inadequate prevention measures. Conclusions:Context indicators help to track changes over time in environmental determinants of health. As part of NCD Surveillance at the RKI, this topic will be continuously developed.

OBJECTIVE:There is increasing evidence that the link between type 2 diabetes (T2D) and mental health may be partly due to shared modifiable risk factors. The present study examined whether a higher predicted T2D risk is associated with poorer self-rated general health (SRH) and mental health (SRMH) as well as depressive and anxiety symptoms among adults without diagnosed diabetes. METHODS:Analyses are based on cross-sectional data from 4,909 adults (18 + years) without known diabetes who participated in the nationwide telephone interview survey German Health Update (GEDA) 2022. The predicted 5-year T2D risk (in %) was assessed with the German Diabetes Risk Score (GDRS) and categorized into very low (<2%), low (2- < 5%), elevated (5- < 10%) and high (≥10%) risk groups. Poisson regression was used to calculate prevalence ratios (PRs) of SRH, SRMH, depressive and anxiety symptoms according to T2D risk categories and models were adjusted for sex, age, education, region, living alone, and social support. RESULTS:Predicted T2D risk (95% confidence interval (CI)) was very low for 60.8% (58.7-63.0%), low for 15.7% (14.2-17.2%), elevated for 10.7% (9.5-12.1%), and high for 12.8% (11.5-14.2%) of adults. Compared to those with very low T2D risk, participants at high T2D risk were less likely to report very good/good SRH (PR; 95% CI: 0.65; 0.56-0.75) or excellent/very good SRMH (0.65; 0.51-0.81) and more likely to have depressive (2.48; 1.70-3.63) or anxiety symptoms (2.50; 1.54-4.05). CONCLUSION:Findings underline that physical and mental health should be considered together in the context of prevention and health promotion strategies.

Background:Knowledge of the risk of cardiovascular disease (CVD) is important for its prevention. Methods:Data from a non-clinical test for the absolute risk of having a heart attack or stroke for the first time in the next ten years is available from 3,271 35- to 69-year-old participants in the GEDA 2022 study without a diagnosis of heart attack or stroke. This risk was categorised as low (< 5 %), still low (≥ 5 % - < 7.5 %), increased (≥ 7.5 % - < 10 %) and high (≥ 10 %). In addition, the self-perceived CVD risk was asked as almost no, low, moderate and high risk. Results:According to the CVD test, 73.5 % of adults were at low risk, 7.8 % were still at low risk, 6.0 % were at increased risk and 12.8 % were at high risk. In contrast, 28.7 % perceived themselves to be at almost no risk, 45.3 % at low risk, 20.4 % at moderate risk and 5.6 % at high risk of CVD. The higher the test-based risk, the lower the proportion of those who perceived themselves as having almost no or only a low risk. Nevertheless, half of the people with an increased to high risk according to the test result perceived themselves to be at almost no or only a low risk. The underestimation of risk was associated with lower education, better mental health and physical activity in both sexes. Conclusions:People who underestimate their risk of CVD despite an unfavourable risk factor profile are a key target group for cardiovascular prevention.

Background:Migration-related factors, such as language barriers, can be relevant to the risk, healthcare and complications of type 2 diabetes in people with a history of migration. Diabetes-related data from people with selected citizenships were analysed on the basis of the nationwide survey German Health Update: Fokus (GEDA Fokus). Methods:The diabetes risk of persons without diabetes (n = 4,698, 18 - 79 years), key figures on healthcare and secondary diseases of persons with type 2 diabetes (n = 326, 45 - 79 years) and on concomitant diseases (n = 326 with type 2 diabetes compared to n = 2,018 without diabetes, 45 - 79 years) were stratified according to sociodemographic and migration-related characteristics. Results:Better German language proficiency is associated with a lower risk of diabetes. Diabetes-related organ complications are observed more frequently in persons who report experiences of discrimination in the health or care sector. Both persons with and without diabetes are more likely to have depressive symptoms when they reported experiences of discrimination. A stronger sense of belonging to the society in Germany is associated with reporting depressive symptoms less often in people without diabetes, but not in people with type 2 diabetes. Conclusions:The differences according to migration-related characteristics indicate a need for improvement in the prevention and care of type 2 diabetes. Migration-sensitive indicators should be integrated into the surveillance of diabetes.

Background A child's attention deficit hyperactivity disorder (ADHD) is associated with strain for the parents. In turn, psychosocial parental strain is associated with higher probabilities for the occurrence of inattention/hyperactivity symptoms (IHS) in their children. The aim of this paper is to assess the association between parental strain, IHS, and a parent-reported ADHD diagnosis of the children. Methodology Based on data from n = 4596 participants of the KiGGS cohort (wave 2: 2014-2017), the type and extent of parental strain was set in relation to IHS and an ADHD diagnosis of the child in cross-sectional analysis. Frequencies, means, beta coefficients, and odds ratios adjusted for sex, age, socioeconomic status, and migration background are reported. Results In individual consideration, a greater number of parental strains were associated with IHS than with an ADHD diagnosis. In a multivariate analysis, financial worries and parenting problems/conflicts with the children were significant predictors of IHS and an ADHD diagnosis, respectively. In addition, four or more types of parental strain were associated with a higher likelihood of both IHS and an ADHD diagnosis. Discussion Financial and child-rearing strain are relevant to parents of children with IHS and an ADHD diagnosis. Interrelationships between parental stress and a child's IHS or an ADHD diagnosis can be assumed. To relieve their burden, prevention can either aim at improving the situation of ADHD-affected families or at improving the family's handling of the child's ADHD.

Zusammenfassung Hintergrund Eine Aufmerksamkeitsdefizit‑/Hyperaktivitätsstörung (ADHS) bei Kindern und Jugendlichen geht mit elterlichen Belastungen einher. Umgekehrt sind psychosoziale Belastungen der Eltern mit dem Auftreten von Unaufmerksamkeits‑/Hyperaktivitätssymptomen (UHS) bei den Kindern assoziiert. In diesem Beitrag wird der Zusammenhang verschiedener Arten und des Umfangs elterlicher Belastungen mit UHS und einer elternberichteten ADHS-Diagnose der Kinder analysiert. Methodik Auf Grundlage der Daten von n = 4596 Teilnehmenden der KiGGS-Kohorte (Welle 2: 2014–2017) wurden in einer querschnittlichen Analyse elterliche Belastungen in Zusammenhang mit UHS sowie einer elternberichteten ADHS-Diagnose der Kinder gebracht. Berichtet werden Häufigkeiten, Mittelwerte sowie für Geschlecht, Alter, sozioökonomischen Status und Migrationshintergrund adjustierte Beta-Koeffizienten und Odds Ratios. Ergebnisse Einzeln betrachtet waren mehr elterliche Belastungsarten mit UHS assoziiert als mit einer ADHS-Diagnose. Multivariat betrachtet erwiesen sich finanzielle Sorgen und Erziehungsprobleme/Konflikte mit den Kindern als signifikante Prädiktoren sowohl für UHS als auch für eine ADHS-Diagnose des Kindes. 4 oder mehr elterliche Belastungen gingen zudem mit einer höheren Wahrscheinlichkeit sowohl für UHS als auch für eine ADHS-Diagnose einher. Diskussion Finanzielle Belastungen und Erziehungsprobleme stellen relevante Belastungen der Eltern von Kindern mit UHS oder ADHS-Diagnose dar. Wechselbeziehungen zwischen elterlichen Belastungen und der ADHS eines Kindes sind anzunehmen. Maßnahmen zur familiären Entlastung können entweder auf eine Verbesserung der familiären Lage (Verhältnisprävention) oder des familiären Umgangs mit dem von ADHS betroffenen Kind (Verhaltensprävention) zielen.

Background:This rapid review examines changes in the mental health of the German child and adolescent population during the COVID-19 pandemic.Methods:The basis are 39 publications, which were identified by means of systematic literature search (until 19.11.2021) and manual search. The databases of the included publications were systematized with regard to their representativeness for the general population, and the indicators used were categorized with regard to the depicted constructs and their reliability.Results:The large majority of the studies took place at the beginning of the pandemic until the summer plateau 2020. Representative studies mainly reported high levels of pandemic-related stress, increases in mental health problems, and negative impacts on the quality of life. Non-representative studies showed mixed results. Vulnerable groups could only be identified to a limited extent. Both routine and care-related data showed declines in the outpatient and inpatient service utilisation during the various waves of the pandemic followed by catch-up effects. Children and adolescents turned out to be more vulnerable during the pandemic compared to adults, but their stress levels varied with the waves of the pandemic and the related containment measures.Conclusions:A future forward-looking crisis and pandemic management requires a close-knit and continuous surveillance of the mental health of children as well as an improved identification of risk groups.

Background:It is well known that there are gender differences in the health behaviour and physical and mental health of children. The COVID-19 pandemic influenced the health and lifestyles of children and adolescents by changing their living conditions. The present work investigates whether gender differences in selected health indicators are evident more than two years after the onset of the pandemic.Methods:In the study Kindergesundheit in Deutschland aktuell (KIDA) (German Children's Health Update), cross-sectional telephone surveys were conducted with parents of 3- to 15-year-olds (n=3,478). Parental information on the general and mental health of the child, on increased need for health care and mental health services, as well as on physical activity and utilisation of sports activities were queried in standardised manner. Gender differences were assessed using Chi2 tests.Results:A total of 91% of the girls and 92% of the boys had their general health assessed as being (very) good by their parents (difference not significant, n.s.). An increased need for care and support was indicated for 10.6% of the 3- to 15-year-olds (girls: 9%, boys: 12%, n.s.). Boys met the physical activity recommendations of the WHO significantly more often (60%) than girls (54%). Good to excellent mental health was reported for 93% of both boys and girls. When changes during the pandemic were reported, no differences were found in the responses for girls compared to boys.Conclusions:Gender differences were found for individual parameters and age groups. These differences must be assessed in the context of other social determinants of health, and need to be considered when planning preventive measures.

Dieser Rapid Review untersucht Veränderungen der psychischen Gesundheit von Kindern und Jugendlichen in der Allgemeinbevölkerung in Deutschland während der COVID-19-Pandemie auf Grundlage von 39 Publikationen, die mittels systematischer Literaturrecherche (Stand 19.11.2022) und Handrecherche identifiziert wurden. Die Datengrundlagen der eingeschlossenen Publikationen wurden bezüglich ihrer Repräsentativität für die Allgemeinbevölkerung systematisiert, die verwendeten Indikatoren hinsichtlich der abgebildeten Konstrukte und ihrer Verlässlichkeit kategorisiert. Die große Mehrzahl der Studien bezog sich auf den Pandemiebeginn bis zum Sommerplateau 2020. Aus repräsentativen Studien wurde überwiegend ein hohes Ausmaß an pandemiebezogenen Belastungen, Zunahmen psychischer Auffälligkeiten und Beeinträchtigungen der Lebensqualität berichtet. Nichtrepräsentative Studien zeigten gemischte Ergebnisse. Vulnerable Gruppen ließen sich nur eingeschränkt identifizieren. Routine- und versorgungsbezogene Daten wiesen Rückgänge der ambulanten und stationären Inanspruchnahme während der Pandemiewellen mit Nachholeffekten aus. Kinder und Jugendliche erweisen sich in der Pandemie als vulnerabler im Vergleich zu Erwachsenen, ihre Belastung variierte jedoch mit den Pandemiewellen und den assoziierten Eindämmungsmaßnahmen. Ein zukünftiges vorausschauendes Krisen- und Pandemiemanagement erfordert eine engmaschige und kontinuierliche Surveillance der psychischen Kindergesundheit sowie eine bessere Identifikation von Risikogruppen.

Einleitung Die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) ist eine der am häufigsten diagnostizierten psychischen Störungen bei Kindern und Jugendlichen in Deutschland. Daten zur Prävalenz der ADHS sowie zu deren Versorgung liegen für Deutschland einerseits aus der epidemiologischen KiGGS-Studie des Robert Koch-Instituts und aus dessen Vertiefungsmodul zur psychischen Gesundheit (BELLA-Studie des Uniklinikums Hamburg-Eppendorf), andererseits aus Abrechnungsdaten der Routineversorgung der gesetzlichen Krankenkassen vor. In der Vergangenheit wurden allerdings steigende administrative Prävalenzzahlen für ADHS-Diagnosen aus Abrechnungsdaten für Krankenkassen berichtet, während epidemiologische Studien auf gleichbleibende, zuletzt sogar sinkende Prävalenzen verweisen. Darüber hinaus ist bisher nur wenig über die klinische Validität administrativer und epidemiologischer ADHS-Diagnosen bekannt. Im Konsortialprojekt INTEGRATE-ADHD werden administrative Daten einer bundesweiten Krankenversicherung und epidemiologische Daten hinsichtlich der Häufigkeit von ADHS bei Kindern und Jugendlichen verglichen und mit einer an der aktuellen AWMF-S3-Leitlinie orientierten klinischen Diagnostik validiert.

Mental health problems in childhood and adolescence may have effects into adulthood. With the KiGGS cohort, data are available for the first time that can be used to track the effects of internalising and externalising problems in childhood or adolescence into young adulthood on a national database. From the KiGGS baseline survey (2003-2006) to KiGGS Wave 2 (2014-2017), a total of 3,546 children and adolescents aged 11 to 17 years were tracked over a period of eleven years into young adulthood. Mental health problems in childhood or adolescence were variously associated with impaired mental health, lower life satisfaction and poorer quality of life and indicators of sexual and reproductive health in young adulthood. When psychosocial protective factors at the time of the KiGGS baseline survey were considered, the longitudinal correlations of internalising and externalising problems with indicators of mental health, life satisfaction and physical and psychological quality of life decreased, as did, to a lesser extent, the correlations with indicators of sexual and reproductive health and, for externalising disorders, also with low educational status (reference: medium). Implications for prevention and intervention are discussed.

Children and adolescents are particularly affected by the COVID-19 pandemic and the official containment measures. However, the effects on their mental health have been little studied. The aim of this narrative review is to summarize existing evidence on the mental health of children and adolescents in the first weeks of the COVID-19 pandemic and during the measures taken to contain it in Germany. First international and national studies draw a differential picture. Children and adolescents showed symptoms of anxiety and depression as well as a reduced quality of life. The closure of childcare and educational facilities and the associated loss of the familiar daytime structure as well as loss of contact and independent learning at home posed considerable challenges for affected children and their families. Spatial confinement at home and the lack of alternative options of stay during the containment measures could also have lead to increased family stress, heightened family aggression, and domestic violence. However, the findings of several studies also show that many families coped with the time during the containment measures mostly well. In the event of possible future pandemics or further waves of the COVID-19 pandemic, the needs of adolescents and their families during the containment measures should be given greater consideration.