Background: Sleep problems can have negative consequences for quality of life, functioning and health. This fact sheet investigates the prevalence of sleep onset problems and problems maintaining sleep among adults in Germany in 2024. Methods: In the Robert Koch Institute’s panel ‘Health in Germany’, n = 27,038 participants (51.1 % female) were surveyed on the frequency of sleep onset problems and problems maintaining sleep over the past four weeks. The analyses were stratified by gender, age and education group. Results: Overall, 16.3 % of participants reported sleep onset problems and 31.7 % reported problems maintaining sleep. Differences were found across gender, age and education group, with higher prevalence among women and individuals in the low education group. Conclusions: Around one in three adults in Germany reports sleep onset problems or problems maintaining sleep. The results highlight the high public health relevance of problems with falling asleep and staying asleep.

Abstract:In the project INTEGRATE-ADHD, routine data from a German statutory health insurance company (DAK-Gesundheit) was linked with data from an online survey and clinical online diagnostics. The period between the documentation of a child's ADHD diagnosis in the routine data and the parent report of the diagnosis in the survey was at least nine and at most 32 months. Clinical online diagnostics according to the German AWMF-S3 guideline took place between three and five months after the survey. Only about two-thirds of the parents reported the ADHD diagnosis of their child in the survey and only just under two-thirds of the administrative ADHD diagnoses were clinically confirmed. Based on data from 1,355 children and adolescents with incident ADHD diagnosis, this study used descriptive statistics and logistic regression to examine whether the time lag between the date of diagnosis documentation and the parent report in the survey or the diagnosis in the clinical examination could explain the discrepancies between the different diagnosis data, for example, due to parents' recall bias or changes in in the children's symptom presentation. The date when the diagnosis was coded could be approximated with the start and end date of the treatment period in which the diagnosis was coded. Subsequently, the effect of the time lag was analyzed using descriptive and multivariate statistics. Even when the date of diagnostic coding was differently approximated, no statistically significant association was observed between the time lag and discrepancies between the diagnosis data. Accordingly, the present analyses did not provide evidence that a time-dependent recall bias of the parents or changes in the presentation of symptoms were associated with unreported or clinically unconfirmed ADHD diagnoses.

This paper aims to describe the study design, methodological approach, conduct, and sample characteristics of the data linkage project INTEGRATE-ADHD. The project was designed to evaluate the concordance and validity of administrative versus epidemiological and clinical ADHD diagnoses, thereby providing insights for health care and health care planning. The assessment of treatment satisfaction among families with children with ADHD, as well as the health economics of ADHD, is also part of the project. A total of 24,880 parents of children and adolescents statutorily insured with DAK-Gesundheit, who had at least one confirmed administrative ADHD diagnosis in one quarter of the 2020 insurance year, were invited to complete an online survey. The survey included questions on ADHD diagnosis, disorder-specific and comorbid psychopathology, health care utilisation, and both the quality of and satisfaction with health care. A random sampling procedure was applied to select 202 participants for a guideline-based clinical online assessment. Administrative, survey, and clinical diagnostic data were subsequently linked at the individual level. Non-responder analyses and sample characteristics were examined with descriptive statistics. Group differences were tested with chi-square and t-tests. Sample representativeness was evaluated. A total of 5,461 parents of youths (mean age = 12.5 years; 25.4

As one of the most commonly diagnosed psychiatric disorders in children and adolescents, reliable prevalence data on attention-deficit/hyperactivity disorder (ADHD) is highly relevant to health policy and health care planning. However, routine data and parental diagnosis reports from surveys − as important data sources on child ADHD − often differ. This study investigates whether parental psychosocial factors are associated with parental diagnosis reporting in German parents whose child is registered with an administrative ADHD diagnosis (ICD-10 F90.0-9) with their statutory health insurance. We expected more parental burden to be associated with a lower likelihood of a parental diagnosis report. Parents of 5,461 children and adolescents who presented with an administrative ADHD diagnosis in 2020 answered online questions about their child’s ADHD diagnosis and various psychosocial characteristics, including parental strain, parental psychological problems, parental ADHD diagnosis, family cohesion and parental health literacy. Chi-square tests and unadjusted linear regressions were used to analyze group differences in parental psychosocial characteristics between parents who reported the ADHD diagnosis and those who did not. Binary logistic regressions were conducted to predict the parental report of their child’s ADHD diagnosis in the survey. Group comparisons revealed that parents who reported their child’s ADHD diagnosis displayed significantly more parental strain, more psychological problems, higher rates of maternal and paternal ADHD, lower levels of family cohesion and lower health literacy than parents who did not report their child’s ADHD diagnosis. The results were partly confirmed in multivariate analysis, where maternal (OR = 3.18) and paternal ADHD (OR = 2.94) turned out to be the strongest predictor of a parental diagnosis report. Contrary to our expectations, parental psychosocial burden, in particular parental ADHD diagnosis, increased the likelihood of a parental report of their child’s ADHD diagnosis, which may point to a greater sensitivity and awareness of affected parents towards their child’s ADHD. The findings suggest that differences in the diagnosis prevalence of child ADHD between routine and survey data may vary as a function of parental psychosocial factors.

Background Converging evidence indicates an adolescent mental health crisis in Western societies that has developed and exacerbated over the past decade. The proposed driving factors of this trend include more screen time, physical inactivity, and social isolation, but their causal influence on mental health is insufficiently understood. Objective The objective of this study is to test whether and based on which predictor variables the development of mental health in adolescents in the last decade can be predicted and to better understand the causal chain of factors at work. Methods We implemented an interpretable machine learning pipeline based on gradient boosting regression with repeated cross-validation to assess the development of mental health throughout adolescence in members of 2 longitudinal cohort studies, the British Millenium cohort (MC; n=8599) and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) cohort (n=1212). In total, 144 (MC) and 102 (KiGGS) predictors assessed at the age of around 13.8 years (MC) and 11.6 years (KiGGS) were used to assess mental health at the ages of around 16.7 years (MC) and 16.4 years (KiGGS). Based on these predictive models, we used permutation-based feature importance analyses to identify relevant predictors and predictor domains. Moreover, we performed partial dependence analyses in a causal inference framework to determine the direct effects of physical inactivity, screen time, and peer problems on the development of mental health. Results The average cross-validated Pearson correlation coefficient (r) between predicted and true mental health in late adolescence was 0.614 (MC) and 0.466 (KiGGS). Feature importance analyses indicated a strong impact of preexisting mental health and weaker impacts of sex (female as a risk factor), physical health (chronic disease as a risk factor), lifestyle, and socioeconomic and family factors (eg, low parental education, income, and mental health as risk factors). Causal inference analyses suggested a strong direct effect of peer relationships, but only a small direct effect of physical inactivity and a very small direct effect of screen time. Conclusions Mental health development during adolescence can be assessed by a combination of variables from early adolescence. Peer problems represent an important direct cause of mental health development, and their deterioration may contribute to the current mental health crisis.

Zielsetzung: Die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) gehört zu den häufigsten kinder- und jugendpsychischen Störungen. Bevölkerungsbezogene ADHS-Diagnosedaten für Kinder und Jugendliche in Deutschland sind einerseits Abrechnungsdaten gesetzlicher Krankenkassen, andererseits aus Elternbefragungen in der KiGGS-Studie des Robert Koch-Instituts. Während administrative Diagnoseprävalenzen in der ersten Dekade des Jahrtausends stark anstiegen, blieben die in der KiGGS-Studie ermittelten Diagnosehäufigkeiten stabil oder waren rückläufig. Ob die Diagnosen leitliniengerecht gestellt wurden, ist für keine der Datenquellen bekannt. Im Rahmen des Data-Linkage-Projekts INTEGRATE-ADHD wurden administrative und epidemiologisch ermittelte ADHS-Diagnosedaten auf Personenebene miteinander verknüpft und mittels einer leitliniengerechten Diagnostik klinisch überprüft. Ziel war es, die verschiedenen Datenquellen zu integrieren, zu einer valideren Prävalenzschätzung der ADHS beizutragen sowie Erkenntnisse zur Versorgungssituation von Kindern und Jugendlichen mit ADHS zu erhalten.

BACKGROUND:ADHD is one of the most common mental disorders in children and adolescents. While international research on health service utilization, barriers to care, and treatment satisfaction is growing, evidence from Germany remains limited. This study aimed to examine the utilization of mental health care services in a sample of German children and adolescents with an administrative ADHD diagnosis registered with their health insurance company. Treatment satisfaction, belief in treatment efficacy and factors influencing mental health care utilization were examined. METHODS:As part of the consortium project INTEGRATE-ADHD, data from 4,948 children and adolescents were analyzed. Parents of 7- to 17-year-olds participated in an online survey answering questions about their child's ADHD health care utilization, treatment satisfaction and efficacy, and factors influencing utilization using established instruments. Sociodemographic factors, geographic characteristics, ADHD symptom severity, and parental psychopathology were also assessed. Descriptive analyses and multivariate logistic regressions were conducted. RESULTS:Approximately 40% of the children and adolescents with an administrative ADHD diagnosis were currently receiving ADHD treatment. The majority of parents (76%) were satisfied with the treatment, and 85% considered the treatment effective. Children with more severe ADHD symptoms had a threefold higher likelihood of receiving treatment, while youths with a migration background were less likely to receive mental health care. The most common reasons for not utilizing mental health care included the treatment having already ended, a lack of available treatment options, long waiting times, a lack of motivation among children, or the inability to continue treatment due to the COVID-19 pandemic. CONCLUSIONS:To overcome the identified barriers in ADHD treatment, we recommend improving access to evidence-based ADHD treatment and expanding its implementation to prevent undertreatment and the associated individual suffering and societal costs.

Background: This article examines discrepancies in the frequency of diagnoses of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents in Germany using information on health care utilisation from both administrative and parent-reported survey data linked at person level. Methods: 5,461 parents of 0- to 17-year-olds insured with DAK-Gesundheit in 2020 and being registered with a confirmed administrative ADHD diagnosis (ICD-10 F90.0-9) in at least one quarter in 2020 (M1Q criterion) were surveyed online on their child’s ADHD diagnosis, utilisation of specialist care and therapeutic service providers. With regard to the presence of a parental report of the child’s documented ADHD diagnosis, administrative data and survey data were bi- and multivariately analysed. Results: The response rate was 21.5 %. ADHD diagnoses were given more frequently in the context of paediatric care, but in the multivariable model with the administrative data only the diagnosis made by mental health professionals (OR = 2.78), in the model with the survey data only utilisation of mental health professionals (OR = 2.99) positively predicted the parental diagnostic report. With regard to the utilisation of therapeutic service providers, only the utilisation of occupational therapy was associated with the parental report of the diagnosis in both data sources. Conclusions: Parental non-reporting of a child’s administrative ADHD diagnosis in survey studies can be in part be explained by utilisation characteristics.

Background: The study examines the psychometric properties of the ADHD section of the semi-structured diagnostic interview ILF-EXTERNAL, which was conducted online via video chat. Methods: As part of the INTEGRATE-ADHD research project, 202 children and adolescents (age M = 12.87 years, SD = 3.04, 28.2 % female) with an administrative diagnosis of ADHD registered with their health insurance company were clinically assessed for the presence of ADHD according to the German ADHD S3 guideline. Using the ILF-EXTERNAL, one parent and, from the age of eight, also the children themselves were interviewed. A proxy rating by a parent was made using the German FBB-ADHS rating scale. In a subsample (n = 65), an independent blind interviewer rated the videorecordings of the ILF-EXTERNAL parent interview to determine the interrater reliability of the ILF-EXTERNAL. Results: All ADHD symptom scales of the ILF-EXTERNAL showed good to excellent internal consistency (α = 0.89 to 0.93). Interrater reliability was high for both categorical and dimensional analyses (κ = 0.78 and κ = 0.81; ICC(1,1) = 0.97 and 0.98). High correlations of the ILF-EXTERNAL parent interview with the FBB-ADHS (r = 0.79 to r = 0.85) and with the ILF-EXTERNAL child interview (r = 0.60 to r = 0.71) demonstrated convergent validity. Conclusions: Sound psychometric properties of the ILF-EXTERNAL were also confirmed for its use in an online setting. High interrater reliabilities demonstrate the quality of the ADHD diagnostics carried out in the consortium project INTEGRATE-ADHD.

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.

BACKGROUND:Fatigue is an unspecific symptom complex characterized by tiredness, lack of energy, and lack of concentration and is of considerable public health relevance, due to its links with incapacity for work, risk of accidents, and increased need for healthcare. METHODS:The analyses are based on data from 9766 adults of the telephone survey "Gesundheit in Deutschland aktuell (GEDA)" 2023. Fatigue was recorded using the Fatigue Assessment Scale (FAS), a validated instrument with 10 questions for self-assessment of fatigue. The scale was dichotomized into yes (at least mild to moderate fatigue) versus no (no fatigue). Population-weighted prevalences of fatigue and associated sociodemographic and health-related factors were calculated in descriptive analyses and multivariable Poisson regression. RESULTS:The overall prevalence of fatigue in adults in Germany is 29.7% (95% CI 28.1-31.2), is highest in 18- to 29-year-olds (39.6% (95% CI 35.0-44.4)), and decreases in the age groups up to 65-79 years (20.6% (95% CI 18.2-23.3)). It is higher again in the very old age group (33.2% (95% CI 28.9-37.7)). Women have a higher risk of fatigue than men (aRR 1.19 (95% CI 1.08-1.32)). Fatigue is significantly associated with age, lower education, chronic illness, depression, and long COVID, regardless of covariates. DISCUSSION:GEDA 2023 is one of the few population-based studies to have collected data on fatigue. The results allow estimates to be made for Germany on the frequency of fatigue and the significance of physical, psychological, and social influencing factors. They can be used as a reference or as a basis for trends over time as part of continuous health monitoring in Germany.

As one of the most frequently diagnosed mental disorders in children and adolescents with sometimes serious individual, family and social consequences, attention deficit/hyperactivity disorder (ADHD) is highly relevant to society and health policy. In Germany, data from statutory health insurance companies has reported increasing ADHD diagnosis prevalence rates over years, while epidemiological data has shown constant and recently even decreasing prevalence rates. The clinical validity of diagnoses from either data sources is unknown. In the framework of the consortium project INTEGRATE-ADHD, 5461 parents of children aged 0 to 17 years with a confirmed administrative ADHD diagnosis insured with the third-largest German statutory health insurance provider (DAK-Gesundheit) in at least one quarter of 2020 were surveyed with the questionnaires from the epidemiological German Health Interview and Examination Survey (KiGGS study) and its in-depth module on child mental health (BELLA study) on their child's ADHD diagnosis and symptoms and on other topics, including comorbidity, utilisation of healthcare services, quality of care and satisfaction, psychosocial risk and protective factors and health-related quality of life. In addition, a subsample of 202 children and adolescents with a clinical diagnosis based on the AMWF S3 guideline on ADHD was analysed. An important aim of the project is to use data linkage on person-level to identify possible causes for the often divergent prevalence estimates from epidemiological and administrative data and to integrate and validate the data sources using a guideline-based clinical diagnosis, thereby contributing to a more accurate population-based prevalence estimate of ADHD in children and adolescents and clarifying actual or supposed contradictions between the data sources. The INTEGRATE-ADHD data linkage project combines administrative, epidemiological and clinical ADHD diagnosis data to create a "three-dimensional view" of the ADHD diagnosis. The results will be used to identify fields of action for healthcare policy and self-administration in the German healthcare system and to derive recommendations for the actors and stakeholders in the field of ADHD. The first results will be published in 2024.

Zusammenfassung Als eine der am häufigsten diagnostizierten psychischen Störungen im Kindes- und Jugendalter mit zum Teil schwerwiegenden individuellen, familiären und sozialen Konsequenzen hat die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) eine hohe gesellschaftliche und gesundheitspolitische Relevanz. Für Deutschland wurden aus den Daten gesetzlicher Krankenkassen über Jahre steigende ADHS-Diagnoseprävalenzen gemeldet, während epidemiologische Daten konstante, zuletzt sogar sinkende Prävalenzraten auswiesen. Die klinische Validität von Diagnosen aus beiden Datenquellen ist unbekannt. Im Konsortialprojekt INTEGRATE-ADHD wurden 5461 Eltern von bei der drittgrößten bundesweiten gesetzlichen Krankenkasse (DAK-Gesundheit) versicherten Kindern im Alter von 0 bis 17 Jahren mit einer gesicherten administrativen ADHS-Diagnose in mindestens einem Quartal des Jahres 2020 mit den Fragebögen der epidemiologischen KiGGS- und BELLA-Studie zur ADHS-Diagnose und -Symptomatik ihres Kindes und zu weiteren Themenbereichen, darunter Komorbidität, Inanspruchnahme von Leistungen des Gesundheitssystems, Versorgungsqualität und -zufriedenheit, psychosoziale Risiko- und Schutzfaktoren sowie gesundheitsbezogene Lebensqualität online befragt. Darüber hinaus wurde eine Substichprobe von 202 Kindern und Jugendlichen mit einer an der AMWF-S3-Leitlinie ADHS orientierten klinischen Diagnostik untersucht. Ein wichtiges Ziel des Projekts ist es, mittels Data-Linkage mögliche Ursachen für die oftmals divergierenden Prävalenzschätzungen aus epidemiologischen und administrativen Daten zu identifizieren sowie die Datenquellen mittels einer leitlinienbasierten klinischen Diagnostik zu integrieren und zu validieren, auf diese Weise zu einer genaueren bevölkerungsbezogenen Prävalenzschätzung der ADHS bei Kindern und Jugendlichen beizutragen sowie tatsächliche oder vermeintliche Widersprüche zwischen den Datenquellen aufzuklären. Das Data-Linkage-Projekt INTEGRATE-ADHD verbindet administrative, epidemiologische und klinische ADHS-Diagnosedaten zu einem „dreidimensionalen Blick“ auf die ADHS-Diagnose. Die Ergebnisse dienen der Identifikation von Handlungsfeldern für die Gesundheitspolitik und die Selbstverwaltung im deutschen Gesundheitssystem sowie der Ableitung von Empfehlungen für die Akteure und Stakeholder im Bereich ADHS. Erste Ergebnisse werden 2024 veröffentlicht.

Background: The consortium project INTEGRATE-ADHD compared administrative data on the presence of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents with the results of a parent survey and a comprehensive clinical assessment based on the S3 guideline of the Association of the Scientific Medical Societies in Germany (AWMF). Due to the COVID-19 pandemic, the clinical assessment was carried out online. Methods: The article describes how a guideline-based clinical assessment of ADHD can be implemented in an online setting. A specially developed diagnostic matrix is presented to illustrate the assessment procedures and the diagnostic decision-making process. The matrix is intended to help the diagnostician to gain an overview of the numerous individual findings that have been collected using different assessment perspectives and methods (e.g. diagnostic interviews, rating scales, performance tests) in order to make a well-founded and transparent diagnostic decision. Discussion: The consortium project INTEGRATE-ADHD has shown that an online assessment can be implemented in a guideline-compliant manner and allows a valid clinical decision. The diagnostic strategy is discussed with reference to international guidelines and recommendations for online diagnostics (e.g. aspects of feasibility, acceptability and safety of the assessment procedures). The challenges and opportunities of using online assessments in clinical practice are also described.

Background: In the project INTEGRATE-ADHD, administrative and parent-reported ADHD diagnosis data of children and adolescents were linked at person level for the first time in Germany. This contribution analyses discrepancies between the data sources, considering sociodemographic characteristics. Methods: Parents of 5,461 0- to 17-year-olds insured with the German statutory health insurance company DAK-Gesundheit in 2020, who had a confirmed administrative diagnosis of ADHD (ICD-10 F90.0-9) in at least one quarter (M1Q criterion), were surveyed online about their child’s ADHD diagnosis and other health and care-related topics. Using logistic regression, associations between the presence of a parental report of the child’s administrative ADHD diagnosis and sociodemographic predictors were analysed. Results: 71.6 % of parents reported their child’s administrative diagnosis of ADHD in the survey. The diagnosis was significantly less likely to be reported by parents of girls, younger children, children with a migration background and children from nuclear families with both biological parents. There were no differences with regard to parental education, urbanisation (urban/rural) or density of care. Bivariate findings were confirmed in the multivariable model. Conclusions: Approximately one third of parents do not report their child’s administrative diagnosis of ADHD. The likelihood of parental reporting varies according to sociodemographic factors. This should be considered when contextualising the data sources in the future.

Background: The health-related quality of life (HRQoL) of individuals living with Attention-deficit/hyperactivity disorder (ADHD) is known to be impaired. Identifying factors that influence HRQoL can provide important information for the development of prevention and intervention programmes for affected children and adolescents. The aim of the present study was to investigate health care-related and psychosocial risk and protective factors for HRQoL in children and adolescents with an administrative ADHD diagnosis. Methods: In the consortium project INTEGRATE-ADHD, n = 4,809 parents of children and adolescents aged 7 to 17 years participated in an online survey between October 2021 and August 2022 and answered questions regarding HRQoL (KIDSCREEN-27), health care utilisation, and psychosocial risk and protective factors. Multiple linear regression analyses were conducted to assess the association between these factors and the five HRQoL dimensions of the KIDSCREEN-27. Results: Findings indicate that parental psychopathology and parental burden were risk factors for lower HRQoL in children and adolescents with ADHD. Further, a positive association was found between the five HRQoL dimensions and the psychosocial factors family climate and social support, indicating that these are protective factors. Conclusions: The results highlight the importance of prevention and intervention programmes for individuals with ADHD that consider parental mental health and aim to strengthen resources such as the availability of good family climate and social support.

Abstract Background Fatigue is a non-specific symptom complex associated with exhaustion, lack of motivation and concentration. It has high public health relevance due to impairments in quality of life and work ability and increased risk of accidents. Fatigue has increasingly gained attention as one of the most common post-acute consequences of SARS-CoV-2 infection. Fatigue is also common among non-infected people and there is a lack of population-based background data. Therefore, we investigated the prevalence and factors associated with fatigue in a population-based epidemiological study in Germany. Methods The analyses are part of the national population-based cross-sectional telephone survey ‘German Health Update’ (GEDA 2023) in adults (3/2023-2/2024). Fatigue was surveyed using the Fatigue Assessment Scale (FAS) and dichotomized into yes (at least mild/moderate) versus no fatigue. The FAS is an instrument for mild-to-moderate fatigue, which must be distinguished from chronic fatigue syndrome (CFS). Weighted analyses of the data from 9,766 adults were carried out descriptively and in multivariable Poisson models, considering sociodemographic and health-related determinants. Results The prevalence of fatigue in Germany was estimated to be 29.7% (95% CI 28.1-31.2) and was highest in 18- to 29-year-olds at 39.6% (35.0-44.4). The prevalence decreased up to 65- to 79- year-olds (20.6% (18.2-23.3)) and was again higher in people aged 80 and over (33.2% (28.9-37.7)). Women had a higher risk of fatigue than men (aRR 1.19 (1.08-1.32)). Lower education (aRR 1.29 (1.13-1.49)) and medium education (aRR 1.13 (1.01-1.27)) were associated with increased risk of fatigue. There were significant associations between fatigue and chronic illness, depressive symptoms and long COVID. Conclusions Fatigue is a common symptom among adults in Germany. Female gender, young and very old adulthood as well as lower education are associated with higher risk of fatigue. Key messages • The correlations between fatigue and socio-demographic variables as well as parameters of physical and mental health provide important indications of groups particularly affected by fatigue. • The fatigue survey in GEDA 2023 is one of the few current European studies that describe the frequency of fatigue in the general population and analyzes health and sociodemographic determinants.

Fatigue ist ein Symptomkomplex, geht mit Müdigkeit, Energiemangel und Konzentrationsschwäche einher und hat durch Zusammenhänge mit Arbeitsunfähigkeit, Unfallgefährdung und erhöhten Bedarfen an Gesundheitsversorgung hohe Public-Health-Relevanz. Die Analysen basieren auf Daten von 9766 Erwachsenen des Surveys „Gesundheit in Deutschland aktuell (GEDA)“ 2023. Fatigue wurde mit der Fatigue Assessment Scale (FAS) erfasst, ein validiertes Instrument mit 10 Fragen zur Selbsteinschätzung von Fatigue. Die Skala wurde dichotomisiert in Ja (mindestens milde bis moderate Fatigue) versus Nein (keine Fatigue). Bevölkerungsgewichtete Prävalenzen von Fatigue und assoziierten soziodemografischen und gesundheitsbezogenen Faktoren wurden in deskriptiven Analysen und multivariabler Poisson-Regression berechnet. Die Prävalenz von Fatigue bei Erwachsenen in Deutschland beträgt 29,7

Background: Attention-deficit/hyperactivity disorder (ADHD) is associated with increased costs for the family, the health care system and the society. Previous cost-of-illness studies in Germany usually focused on prevalent ADHD. This study addressed the research gap on health care resource utilisation and costs of children and adolescents with incident ADHD diagnosis using nationwide claims data from the statutory health insurance DAK-Gesundheit. Methods: A matched-control design (propensity score matching, 1:3 ratio) was used to examine the health care costs of incident ADHD patients compared with a non-ADHD control group, considering an observation period of four quarters. Besides bivariate statistics, multivariate analyses of total costs were used to consider relevant covariates. Results: Total health care costs for children and adolescents with ADHD in the first year after diagnosis exceeded those of the control group by € 1,505.3. According to the multivariate analysis, the group with incident ADHD had significantly higher (2.86-fold) health care costs when compared with non-ADHD peers. Sensitivity analyses proved these findings. In addition, the analyses identified children’s age and comorbidity index to be significantly associated with increased costs. Conclusions: ADHD in children and adolescents is associated with a significant economic burden. The results emphasise the need for social awareness, prevention, appropriate treatment and research efforts.