Mental health care use among children and adolescents in Germany: results of the longitudinal BELLA study
Abstract
Data on mental health care use of children and adolescents in Germany is scarce. This study investigates the degree of mental health care use, its trajectories and influencing factors among children and adolescents in Germany, using longitudinal data of the BELLA study. The BELLA study is the mental health module of the representative German National Health Interview and Examination Survey for children and adolescents (KiGGS). Baseline data of N = 2,863 participants aged 7-17 years were collected between 2003 and 2006. The study sample was followed up in three additional measurement points, assessing general mental health problems and impairment, specific mental health problems, and mental health care use. In the current study, we analysed data from the first three measurement points. At baseline, 5.9 % of all participants used mental health care in the past 12 months. Among those with general mental health problems, 29.5 % sought professional help. Only a minority of participants reporting mental health care use at baseline also sought help at the following two measurement points. Analysing a random intercept only model, mental health care use was found to be more likely among participants living in larger communities as well as in the Eastern part of Germany, among those participants with impairment of mental health problems, and signs of externalizing problems. Our results indicate a temporary character of mental health care use. Participants' impairment was identified to be the strongest predictor of mental health care use.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Only a small proportion of adolescents and young adults with chronic conditions in need of mental health services actually receives professional support.
“Only a small proportion of AYA with chronic conditions in need of mental health services actually receives professional support [6, 14, 15].”
In a German sample, less than 30% of adolescents and young adults with relevant mental health disturbances used mental health care offers in the past 12 months.
“In a German sample, less than 30% of AYA with relevant mental health disturbances used mental health care offers (consulted a psychologist, psychiatrist, or psychotherapist) in the past 12 months [21].”
From Effectiveness and cost-effectiveness of guided Internet- and mobile-based CBT for adolescents and young adults with chronic somatic conditions and comorbid depression and anxiety symptoms (youthCOACHCD): study protocol for a multicentre randomized controlled trial (2020) · cites this paper as [21]
Cites
R: A Language and Environment for Statistical Computing
R Core Team (2000) · doi:10.32614/r.manuals · Cited by 355,706 · see citing works
The Strengths and Difficulties Questionnaire: A research note
Goodman, R. (1997) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.1997.tb01545.x · Cited by 14,908 · see citing works
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz
(2013) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/103.1437-1588 · Cited by 11,769 · see citing works
Revisiting the Behavioral Model and Access to Medical Care: Does it Matter?
Andersen, R. M. (1995) · Journal of Health and Social Behavior · doi:10.2307/2137284 · Cited by 9,831 · see citing works
(1991) · Medical Entomology and Zoology · Cited by 8,071 · see citing works
Psychometric properties of the strengths and difficulties questionnaire
GOODMAN, R. (2001) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200111000-00015 · Cited by 6,813 · see citing works
Linear Mixed-Effects Models using 'Eigen' and S4
Bates, D. M., Maechler, M., Bolker, B. M., & Walker, S. C. (2015) · Cited by 5,924 · see citing works
(2007) · PubMed Central · Cited by 2,521 · see citing works
BIRMAHER, B., BRENT, D. A., CHIAPPETTA, L., BRIDGE, J., MONGA, S., & BAUGHER, M. (1999) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199910000-00011 · Cited by 2,252 · see citing works
Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998) · Journal of Abnormal Child Psychology · doi:10.1023/a:1022602400621 · Cited by 1,772 · see citing works
Goodman, R. (1999) · Journal of Child Psychology and Psychiatry · doi:10.1111/1469-7610.00494 · Cited by 1,760 · see citing works
Wang, P. S., Aguilar-Gaxiola, S., Alonso, J., Angermeyer, M. C., Borges, G., Bromet, E. J., Bruffaerts, R., de Girolamo, G., de Graaf, R., Gureje, O., et al. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61414-7 · Cited by 1,655 · see citing works
Merikangas, K. R., He, J.-P., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., Georgiades, K., Heaton, L., Swanson, S., & Olfson, M. (2011) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2010.10.006 · Cited by 1,579 · see citing works
Avenevoli, S. (2012) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2011.160 · Cited by 1,149 · see citing works
Weissman, M. M., Orvaschel, H., & PADIAN, N. S. (1980) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-198012000-00005 · Cited by 894 · see citing works
Child and adolescent mental disorders: the magnitude of the problem across the globe.
Belfer, M. (2008) · Journal of Child Psychology and Psychiatry and Allied Disciplines · doi:10.1111/j.1469-7610.2007.01855.x · Cited by 875 · see citing works
The prevalence and correlates of untreated serious mental illness.
(2001) · PubMed Central · Cited by 780 · see citing works
Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998) · Journal of Abnormal Child Psychology · doi:10.1023/a:1022606501530 · Cited by 678 · see citing works
Faulstich, M. E., Carey, M. P., Ruggiero, L., Enyart, P., & Gresham, F. M. (1986) · American Journal of Psychiatry · doi:10.1176/ajp.143.8.1024 · Cited by 634 · see citing works
Mental Health Service Use in the Community and Schools: Results from the Four-Community MECA Study
Leaf, P. J., Alegria, M. M., Cohen, P. R., Goodman, S. H., Horwitz, S. M., Hoven, C. W., Narrow, W. E., Vaden-Kiernan, M., & Regier, D. A. (1996) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199607000-00014 · Cited by 608 · see citing works
Evidence That School-Age Children Can Self-Report on Their Health
Riley, A. W. (2004) · Ambulatory Pediatrics · doi:10.1367/a03-178r.1 · Cited by 595 · see citing works
Rating scales for use in drug studies with children
Conners, C. K. (1973) · Cited by 589 · see citing works
Achenbach, T. M. (2000) · American Psychological Association eBooks · doi:10.1037/10517-028 · Cited by 566 · see citing works
The DSM-IV Rates of Child and Adolescent Disordersin Puerto Rico
CANINO, G. J., Shrout, P. E., Rubio‐Stipec, M., Bird, H., Bravo, M., Ramírez, R., Chavez, L. M., Alegria, M. M., Bauermeister, J. J., Hohmann, A. A., et al. (2004) · Archives of General Psychiatry · doi:10.1001/archpsyc.61.1.85 · Cited by 453 · see citing works
Costello, E. J., He, J., Sampson, N. A., Kessler, R. C., & Merikangas, K. R. (2013) · Psychiatric Services · doi:10.1176/appi.ps.201100518 · Cited by 446 · see citing works
Building a Model to Understand Youth Service Access: The Gateway Provider Model
Stiffman, A. R., Pescosolido, B. A., & Cabassa, L. J. (2004) · Mental Health Services Research · doi:10.1023/b:mhsr.0000044745.09952.33 · Cited by 416 · see citing works
Klasen, H., Woerner, W., Dieter Wolke, C., Meyer, R., Overmeyer, S., Kaschnitz, W., Rothenberger, A., & Goodman, R. (2000) · European Child & Adolescent Psychiatry · doi:10.1007/s007870070030 · Cited by 410 · see citing works
Psychiatric Disorders in Norwegian 8- to 10-Year-Olds
HEIERVANG, E., STORMARK, K. M., LUNDERVOLD, A. J., HEIMANN, M., GOODMAN, R., POSSERUD, M.-B., ULLEBØ, A. K., PLESSEN, K. J., BJELLAND, I., LIE, S. A., et al. (2007) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e31803062bf · Cited by 392 · see citing works
Normative data and scale properties of the German parent SDQ
Woerner, W., Becker, A., & Rothenberger, A. (2004) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-004-2002-6 · Cited by 365 · see citing works
Roy, B. V., Veenstra, M., & Clench‐Aas, J. (2008) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2008.01942.x · Cited by 348 · see citing works
Wu, P., Hoven, C. W., Bird, H., Moore, R. E., Cohen, P. R., Alegria, M. M., Dulcan, M. K., Goodman, S. H., Horwitz, S. M., Lichtman, J. H., et al. (1999) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199909000-00010 · Cited by 334 · see citing works
Mental health in pediatric settings: distribution of disorders and factors related to service use.
BRIGGS-GOWAN, M. J., HORWITZ, S. M., SCHWAB-STONE, M. E., LEVENTHAL, J. M., & LEAF, P. J. (2000) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200007000-00012 · Cited by 320 · see citing works
Woerner, W., Becker, A., Friedrich, C., Rothenberger, A., Klasen, H., & Goodman, R. (2002) · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024//1422-4917.30.2.105 · Cited by 316 · see citing works
Factors Associated With Child Mental Health Service Use in the Community
Verhulst, F. C., & van der Ende, J. (1997) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199707000-00011 · Cited by 312 · see citing works
as the BELLA study group, Ravens‐Sieberer, U., Wille, N., Erhart, M., Bettge, S., Wïttchen, H., Rothenberger, A., Herpertz‐Dahlmann, B., Resch, F., Hölling, H., et al. (2008) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-008-1003-2 · Cited by 303 · see citing works
Self-citationLogan, D. E., & King, C. A. (2001) · Clinical Psychology Science and Practice · doi:10.1093/clipsy.8.3.319 · Cited by 291 · see citing works
Lange, M., Kamtsiuris, P., Lange, C., Rosario, A. S., Stolzenberg, H., & Lampert, T. (2007) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-007-0219-5 · Cited by 289 · see citing works
Kinder und Jugendliche mit Migrationshintergrund in Deutschland
Schenk, L., Ellert, U., & Neuhauser, H. K. (2007) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-007-0220-z · Cited by 260 · see citing works
Essau, C. A. (2005) · Depression and Anxiety · doi:10.1002/da.20115 · Cited by 251 · see citing works
Developmental pathways in depression: Multiple meanings, antecedents, and endpoints
Harrington, R., Rutter, M. L., & Fombonne, E. J. (1996) · Development and Psychopathology · doi:10.1017/s095457940000732x · Cited by 226 · see citing works
Use, Persistence, and Intensity: Patterns of Care for Children's Mental Health Across One Year
Farmer, E. M. Z., Stangl, D. K., Burns, B. J., Costello, E. J., & Angold, A. C. (1999) · Community Mental Health Journal · doi:10.1023/a:1018743908617 · Cited by 225 · see citing works
Formal Help-Seeking Behavior of Adolescents Identifying Themselves as Having Mental Health Problems
Saunders, S. M., Resnick, M. D., Hoberman, H. M., & Blum, R. W. (1994) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199406000-00013 · Cited by 218 · see citing works
Factors Associated With Adolescent Mental Health Service Need and Utilization
Zwaanswijk, M., van der Ende, J., Verhaak, P. F. M., Bensing, J. M., & Verhulst, F. C. (2003) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000046862.56865.b7 · Cited by 218 · see citing works
Magaziner, J., Zimmerman, S. I., Gruber‐Baldini, A. L., Hebel, J. R., & Fox, K. M. (1997) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a009295 · Cited by 217 · see citing works
Demographic factors in the use of children's mental health services.
Cohen, P. R., & Hesselbart, C. S. (1993) · American Journal of Public Health · doi:10.2105/ajph.83.1.49 · Cited by 205 · see citing works
[Social class index in the Federal Health Survey].
Winkler, J., & Stolzenberg, H. (1999) · PubMed · Cited by 198 · see citing works
Barkmann, C., & Schulte‐Markwort, M. (2010) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2009.102467 · Cited by 142 · see citing works
The BELLA study group, Ravens‐Sieberer, U., Otto, C., Kriston, L., Rothenberger, A., Döpfner, M., Herpertz‐Dahlmann, B., Barkmann, C., Schön, G., Hölling, H., et al. (2014) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-014-0638-4 · Cited by 124 · see citing works
Self-citationThe BELLA Study Group, Barkmann, C., Erhart, M., & Schulte‐Markwort, M. (2008) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-008-1013-0 · Cited by 113 · see citing works
Self-citationPredictors of Service Use for Mental Health Problems Among British Schoolchildren
Ford, T. J., Hamilton, H., Meltzer, H., & Goodman, R. (2007) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2007.00449.x · Cited by 103 · see citing works
How impaired are children and adolescents by mental health problems? Results of the BELLA study
Wille, N., Bettge, S., Wittchen, H.-U., Ravens-Sieberer, U., & The BELLA study group (2008) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-008-1005-0 · Cited by 101 · see citing works
Self-citationChild and adolescent mental health service use in Finland
Sourander, A., Helstelä, L., Ristkari, T., et al. (2001) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s001270170047 · Cited by 100 · see citing works
Hintzpeter, B., Metzner, F., Pawils, S., Bichmann, H., Kamtsiuris, P., Ravens-Sieberer, U., Klasen, F., & group, T. B. S. (2014) · Kindheit und Entwicklung · doi:10.1026/0942-5403/a000148 · Cited by 76 · see citing works
Rowe, K. S., & Rowe, K. (1997) · Research on Child and Adolescent Psychopathology · doi:10.1023/a:1022678013979 · Cited by 60 · see citing works
Levav, I., Jacobsson, L. H., Tsiantis, J., et al. (2004) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-004-0427-6 · Cited by 41 · see citing works
Somatic and mental health service use of children and adolescents in Germany (KiGGS-study)
Wölfle, S., Jost, D., Oades, R. D., Schlack, R., Hölling, H., & Hebebrand, J. (2014) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-014-0525-z · Cited by 29 · see citing works
Self-citationLipman, R. S. (1971) · PubMed · Cited by 29 · see citing works
Runge, A. J., Beesdo‐Baum, K., Lieb, R., & Wittchen, H.-U. (2008) · Verhaltenstherapie · doi:10.1159/000113890 · Cited by 25 · see citing works
Reinhard, W., & Remschmidt, H. (1999) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026//0084-5345.28.3.177 · Cited by 23 · see citing works
Posserud, M.-B. R., & Lundervold, A. J. (2013) · The Scientific World JOURNAL · doi:10.1155/2013/247283 · Cited by 19 · see citing works
Screen for Child Anxiety Related Emotional Disorders--German Version
Plass, A., Barkmann, C., Mack, B., et al. (2004) · PsycTESTS Dataset · doi:10.1037/t18716-000 · Cited by 1 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Wagner, G., Zeiler, M., Waldherr, K., Philipp, J., Truttmann, S., Dür, W., Treasure, J. L., & Karwautz, A. F. K. (2017) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-017-0999-6 · Cited by 151 · see citing works
“This is in line with a recent study of mental health care use in Germany (longitudinal BELLA study) and in the Netherlands, showing the highest treatment rates within specialist centres for attention-deficit/hyperactivity disorders [10, 41].”
ResultGeirhos, A., Domhardt, M., Lunkenheimer, F., Temming, S., Holl, R. W., Minden, K., Warschburger, P., Meissner, T., Mueller-Stierlin, A. S., & Baumeister, H. (2022) · BMC Pediatrics · doi:10.1186/s12887-022-03134-3 · Cited by 37 · see citing works
COACH consortium, Lunkenheimer, F., Domhardt, M., Geirhos, A., Kilian, R., Mueller-Stierlin, A. S., Holl, R. W., Meissner, T., Minden, K., Moshagen, M., et al. (2020) · Trials · doi:10.1186/s13063-019-4041-9 · Cited by 37 · see citing works
Canals-Sans, J., Hernández-Martínez, C., Sáez-Carles, M., & Arija-Val, V. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.07.023 · Cited by 30 · see citing works
Reinauer, C., Platzbecker, A. L., Viermann, R., Domhardt, M., Baumeister, H., Foertsch, K., Linderskamp, H., Krassuski, L., Staab, D., Minden, K., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.27622 · Cited by 22 · see citing works
Epidemiologische Beiträge zur Klinischen Psychologie
Beesdo-Baum, K., Höfler, M., Jacobi, F., & Wittchen, H.-U. (2020) · Klinische Psychologie & Psychotherapie · doi:10.1007/978-3-662-61814-1_3 · Cited by 6 · see citing works
- Authors
- The BELLA study group, Hintzpeter, B., Klasen, F., Schön, G., Voss, C., Hölling, H., & Ravens-Sieberer, U.
- Affiliations
- University Medical Center Hamburg-Eppendorf (DE)
- Robert Koch Institute (DE)
- Venue
- European Child & Adolescent Psychiatry
- Published
- 2015-02-05
- Volume
- 24
- Issue
- 6
- Pages
- 705-713
- ISSN
- 1018-8827 (ISSN-L)
- 1435-165X
- OpenAlex
- W2082303056
- Cited by
- 77
- References
- 61
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 2 · 2023: 10 · 2022: 8 · 2021: 7 · 2020: 9 · 2019: 9 · 2018: 4 · 2017: 5 · 2016: 4 · 2015: 2 · 2014: 2
- FWCI
- 8.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- European Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- RWTH Publications (RWTH Aachen) (submittedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Health Professions › General Health Professions › Health and Medical Studies
- Keywords
- mental health service utilization, children and adolescents, help-seeking, psychiatric disability, externalizing problems, community size, regional variation, KiGGS, predictors of help-seeking
- MeSH terms
- Adolescent, Mental Disorders, Child, Cross-Sectional Studies, Female, Germany, Health Surveys, Humans, Longitudinal Studies, Male, Mental Health, Patient Acceptance of Health Care, Risk Factors, Cohort Studies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
