Objective In recent years, the number of children and adolescents experiencing gender incongruence (GI) and gender dysphoria (GD) has increased within the German healthcare system. The present study assesses healthcare structures, opportunities for referral and clinical confidence regarding treatment of children and adolescents with GI/GD of healthcare professionals, with an emphasis on regional differences between rural/urban areas, eastern/western and northern/southern Germany. Method An online survey was answered by N = 868 healthcare professionals. Ratings are analyzed using descriptive statistics and group comparisons. Results Healthcare professionals rated the healthcare structure for children and adolescents with GI/GD as partially developed. Regarding referral opportunities, 22% stated that they do not know to whom they could refer patients. Clinical confidence was rated as partly secure. However, if gender-affirming medical interventions are not considered, the average clinical confidence increases. Conclusion The geographical comparisons indicate no differences in healthcare between eastern/western and northern/southern regions. Nevertheless, healthcare structures in urban areas were rated as more positive as in rural areas. To ensure access to healthcare for children and adolescents with GI/GD and their families, it is essential to expand services, especially in rural areas. Healthcare professionals’ clinical confidence should improve to adequately meet the growing demand for care, which could be accomplished by appropriate education and training.

BACKGROUND:Adolescence and early adulthood are periods of increased vulnerability for psychiatric disorders, when trauma and personality development converge on shared and distinct, often unknown, brain signatures. METHODS:We used sparse partial least squares (SPLS) to identify multivariate signatures between voxelwise gray matter volume (GMV) and the following 3 domains: childhood trauma, personality, and depressivity. We performed structural equation modeling (SEM) among these domains, predicted functional outcome at 9-month follow-up via support vector machine classification, and correlated the SPLS signatures with resilience, coping, and visual dysfunctions. All models were cross-validated in the discovery sample [n = 633; 52.9% female, mean [SD] age = 25.41 [5.98] years] and validated in the replication sample (n = 343; 53.0% female, 24.69 [5.72] years) of the multisite prospective PRONIA (Personalised Prognostic Tools for Early Psychosis Management) cohort, comprising individuals with recent-onset depression or psychosis, psychosis risk syndromes, and healthy control individuals. RESULTS:We identified the following 3 signatures of interest: 1) depressivity, linked to reduced GMV in limbic regions; 2) childhood trauma, associated with GMV in thalamic, frontotemporal, and parietal regions; and 3) a trauma-personality-depressivity signature, relating childhood trauma, personality, and depressivity to GMV in thalamic, occipital, temporal, and limbic regions. SEM revealed that childhood trauma was associated with depressivity directly and also indirectly via a maladaptive personality structure. The trauma-personality-depressivity signature was the strongest predictor of poor functional outcome (balanced accuracy [BAC]Discovery = 75.8%, BACReplication = 83.2%). The depressivity and trauma-personality-depressivity signatures were linked to deficient resilience and coping styles as well as visual dysfunctions. CONCLUSIONS:Childhood trauma, personality, and depressivity are associated with shared and distinct brain signatures spanning the affective-psychotic spectrum. If these factors converge, current and future mental health may be compromised.

BACKGROUND:Identifying neuroanatomical correlates of clinical prediction models may offer pathophysiological insights into the clinical high-risk states for psychosis (CHR-P) and unveil new therapeutic targets for early intervention. STUDY DESIGN:We used the North American Prodrome Longitudinal Study (NAPLS-2) risk calculator to obtain psychosis risk scores for 315 CHR-P (M = 23.85, SD = ± 5.64; female: 164) and 295 recent-onset depression (M = 25.11, SD = ± 6.21; female: 144) patients from the Personalized Prognostic Tools for Early Psychosis Management (PRONIA) cohort. Voxel-based morphometry was employed to examine associations between risk scores, gray matter volume (GMV), and white matter volume (WMV). Post-hoc, we used eigenvariate extraction to explore network-level alterations associated with significant regions. Moderation analyses were conducted to understand the influence of individual NAPLS-2 risk variables on these networks (False Discovery Rate-corrected). STUDY RESULTS:Reduced hippocampal GMV (${k}_E$ = 847 voxels) and cerebellar WMV (${k}_E$ = 10 423 voxels) were associated with higher risk scores. Post-hoc analyses revealed parallel structural alterations between these regions and the entorhinal cortex, anterior cingulate cortex, thalamus, anterior limb of the internal capsule, and pons. Moderation analyses showed that family risk (first-degree relative with psychotic disorder), verbal memory, and social functioning significantly influenced structural patterns. CONCLUSIONS:Our results provide evidence for neuroanatomical correlates of the NAPLS-2 model, with alterations in hippocampal circuits suggesting a key prognostic role in the development of neurocognitive and psychosocial deficits across diagnostic boundaries. Future longitudinal studies incorporating multimodal imaging techniques should validate these findings as potential biomarkers for psychosis risk.

Im März 2025 wurde die Leitlinie Geschlechtsinkongruenz und Geschlechtsdysphorie im Kindes- und Jugendalter – Diagnostik und Behandlung (S2k) AWMF-Register-Nr. 028 – 014 veröffentlicht. Sie soll allen Fachpersonen im Gesundheitswesen, die auf Kinder und Jugendliche mit nonkonformer Geschlechtsidentität treffen, eine Orientierung für eine bestmöglich fachlich informierte Versorgung auf dem aktuellen Stand der medizinischen Erkenntnis geben. Die Indikationsstellung zu einer Unterbrechung der endogenen Pubertät und/oder zielgeschlechtlicher Hormonbehandlung erfolgen/erfolgt durch eine Fachperson aus dem Bereich der Kinder- und Jugendpsychiatrie und -psychotherapie, Jugendpsychotherapie mit ausgewiesener klinischer Expertise. Der somatische Teil der Indikation soll im Hinblick auf ihre Voraussetzungen (pubertäres Reifestadium, Abwesenheit von somatischen Kontraindikationen etc.) durch eine erfahrene pädiatrisch-endokrinologische Fachperson gestellt werden.

BACKGROUND:Specific cognitive difficulties are common in major depressive disorder, impacting functioning and quality of life. Yet, the timing of their emergence and longitudinal course remains poorly understood. This study aimed to characterise longitudinal cognitive functioning following recent onset depression and its association with changes in depressive symptoms. METHODS:Longitudinal data from the PRONIA (Personalised Prognostic Tools for Early Psychosis Management) cohort recruited from ten European sites were used to evaluate trajectory differences between Healthy Controls (HC) and individuals experiencing recent onset depression (ROD). Linear mixed effect models were used with group-by-time interaction term for trajectory differences between baseline and nine-month follow-up, and the associations between changes in depression symptoms and cognitive functioning among ROD. RESULTS:The sample comprised 420 participants (ROD, N = 151; HC, N = 269) aged 15-40 years (M = 25.4, SD = 6.1; 55% female). Two distinct group-level cognitive trajectories were observed. First, a similar trajectory (i.e., no difference) to HC in visual memory, attention span, verbal learning and memory, visuospatial working memory, emotion recognition, and processing speed. A stable deficit trajectory was observed in mental flexibility, auditory verbal working memory, phonetic and semantic verbal fluency among the ROD group. Analysis within ROD group suggested that these outcomes were unrelated to reductions in depressive symptoms. Changes in visual memory, visuospatial working memory, sustained attention, and processing speed were associated with changes in depressive symptoms, despite being unrelated to baseline variations in depressive symptoms, possibly suggesting a sensitivity to state effects of illness, regardless of baseline severity. CONCLUSIONS:Specific cognitive difficulties are already evident at the first depressive episode and may endure in the short-medium term, irrespective of depressive course. Tailored treatment addressing cognition should be provided early to promote cognitive health and functional recovery.

BACKGROUND:Childcare centres for toddlers and preschool-aged children serve as a setting crucial to mental development, as stable relationships with caregivers and peers outside the family form. Children with early mental health disorders, especially externalising behaviours, are at increased risk of being excluded from access to these institutional services. METHODS:The retrospective study investigates partial or full exclusion from childcare centre attendance among toddlers and preschoolers (N = 177) who received psychiatric day clinic treatment within two periods (2018/2019 and 2023/2024). We compared excluded and non-excluded children regarding clinical parameters in a binary logistic regression. Furthermore, treatment trajectories were examined to assess reintegration into childcare settings as a potential therapeutic outcome. RESULTS:Among the patients in the psychiatric day clinic for toddlers and preschoolers, the rate of exclusion from childcare centre attendance was 25.5% (2023/2024) and 8.0% (2018/2019), respectively. Boys were predominantly excluded from childcare centre attendance with 66.7% (2018/2019) and 92.3% (2023/2024). Overall for both cohorts, while male sex (p = 0.028) and cohort membership in the 2023/24 cohort (p = 0.009) predicted exclusion, other investigated variables (i.e., socioeconomic status, migration status, parental psychiatric condition) did not show an effect. In 78.1% of the excluded patients in the combined samples, (partial) reintegration or improvement of social integration was recorded or initiated during treatment. CONCLUSIONS:In our study, exclusion from childcare attendance differed between 2018/2019 and 2023/2024 in toddler and preschool children, especially affecting boys. In line with the UN Convention on the Rights of the Child, 1989, ensuring inclusive access to early education regardless of physical or mental impairments should be an important therapeutic goal. Mental health professionals should pay special attention to and actively support prevention and reintegration regarding early life exclusion experiences from childcare centres.

In March 2025 the guidelines on Gender incongruence and gender dysphoria in childhood and adolescence-Diagnostics and treatment (S2k) AWMF Register No. 028-014 were published. The aim was to provide all specialists in the healthcare system who encounter children and adolescents with nonconforming gender identity with an orientation for the best possible professionally informed care based on the latest medical knowledge. The assessment of the indications for interruption of an endogenous puberty and/or targeted sex hormone treatment is carried out by a specialist in child and adolescent psychiatry and psychotherapy, adolescent psychotherapy with proven clinical expertise. The somatic part of the indications should be carried out by an experienced pediatric endocrinological specialist with respect to the prerequisites (pubertal maturity stage, absence of somatic contraindications, etc.).

Background Since there is little data on the use of health services by minor patients diagnosed with gender dysphoria (GD), we performed an analysis of German claims data to compare characteristics of gender health service utilization in minors and adults. Method We investigated trends in health service utilization, hormonal treatment initiation, and sex ratios for GD between 2010 and 2021. We compared the age groups of minors and young adults, as well as patients assigned female and male at birth. Results Within the study period, GD incidence changed from 14 to 48 per 100,000 insured persons (RR per year = 1.12, 95% CI = 1.11-1.13) in minors and from 12 to 39 per 100,000 (RR = 1.15 per year, CI = 1.14-1.16) in adults. The majority of minors (72%) as well as adults (67%) in this study were patients assigned female at birth. The proportion of patients who started hormonal treatments within two years after initial diagnosis was relatively higher in those assigned female at birth (34%) than among those assigned male at birth (20%) among minors, but relatively lower in those assigned female at birth (50%) than among those assigned male at birth (63%) among adult patients. Interpretation The incidence of health service utilization for GD under the age of 30 has increased substantially since 2010. However, similar time trends and sex ratios in adults (18-30 y) and adolescents (13-17 y) indicate that the reported trends are not specific to adolescents.

Before carrying out a medical or psychotherapeutic procedure, health professionals are obliged to obtain the patient's consent. In the case of underage patients, psychotherapists and doctors must check on a case-by-case basis whether the requirements for capacity to consent are met. Based on the procedure for minors with gender incongruence/gender dysphoria, the article describes the prerequisites for assessing the capacity to consent, in particular the complexity of the decision to be made, key ethical aspects and the normative context. A structured approach is proposed, from developmentally appropriate information to the concrete, individual assessment of the capacity to consent based on suitable criteria and reflections, if necessary also in a procedural form.

Children and adolescents with gender dysphoria (GD) and their families often have contact with the healthcare system. Few to no studies are available that describe the care experiences and needs from the perspective of the affected patient group and from the perspective of relevant groups of healthcare professionals (pediatricians, child and adolescent psychiatrists and GD experts). The article provides a multiperspective overview regarding the health care situation of children and adolescents with GD in German-speaking countries. Quantitative and qualitative data from two third-party funded projects TRANS*KIDS and TRANSKIDSCARE are presented. The need for health care for children and adolescents with GI is increasing. The participants in both studies reported positive (previous) experiences in the healthcare system, but many of them also mentioned negative (previous) experiences in the healthcare system, ranging from misgendering to refusal of treatment, often due to a lack of knowledge about GD on the part of professionals treating them. As a result, participants see a need for further training for healthcare professionals working with children and adolescents with GD. The multiperspective experiences and needs identified in both projects show deficits and discrepancies in the healthcare of children and adolescents with GD. Comprehensive and transparent care structures and treatment guidelines for professionals are needed to improve health care for this group of patients.