Hannah Schmidt

In Europe, mental health problems among children represent an increasing public health concern. Longstanding, trust-based relationships between pediatricians and families place pediatric primary care in a key position for early identification. Given the limited consultation time, feasible and structured procedures for early identification are needed. This narrative review identifies standardized mental health assessment instruments for pediatric primary care and discusses considerations for their implementation. A structured search of PubMed, Web of Science, and Scopus was conducted in August 2024. Peer-reviewed studies published since 2013 that examined standardized mental health assessments in pediatric primary care were included. Instruments were evaluated with regard to psychometric quality and clinical usefulness. Five instruments were identified: the Strengths and Difficulties Questionnaire (SDQ), the Pediatric Symptom Checklist (PSC), its short form PSC-17, the Ages & Stages Questionnaires: Social-Emotional (ASQ:SE), and the Child Behavior Checklist (CBCL). All showed adequate psychometric properties. The SDQ, PSC/PSC-17, and ASQ:SE were considered feasible for routine care. The CBCL, despite strong psychometric properties, appeared less suitable due to its length and scoring complexity. Standardized mental health assessment instruments may support early identification of mental health problems in primary care and facilitate timely referral to treatment. Nonetheless, they should complement rather than replace comprehensive clinical assessment. Successful implementation requires appropriate training, structured referral pathways, and sufficient access to follow-up mental health services. • Pediatricians play a central role in early identification of mental health problems among children. There is currently no consensus on which standardized assessments are suitable for pediatric primary care. • This narrative review identifies assessments relevant to pediatric primary care and highlights ethical and structural considerations, with particular emphasis on the responsibility to ensure appropriate follow-up care.

Background and aims: The current study aimed to analyze impairments in daily life functioning (DLF) in vocational students with Internet Gaming Disorder (IGD) and Social Network Use Disorder (SNUD). While diagnostic requirement for IGD has been defined and the functionally impairing nature has been demonstrated, SNUD is a relatively new phenomenon with less evidence. Methods: A diagnostic interview ( n = 937) was conducted in a sample of students, of which 279 met the adapted DSM-5 criteria, with 70 reporting social networking and 29 gaming as their main activity. For screening, the Compulsive Internet Use Scale (CIUS) was used and the Internet Use Disorder – Criterion-based Assessment Tool (I-CAT) served as diagnostic measure. Impairment was assessed using a subset of items taken from the WHO Disability Scale. Results: In a prior analysis, overall impairments in DLF among students with and without IUD were compared, indicating higher impairments for the IUD-group. In our study, the DSM-5 criteria appear to be appropriate to differentiate between pathological (IUD-group) and healthy internet users (non-IUD group) in terms of DLF. Odds Ratios ranged between 0.597 and 1.340 for impairments in DLF. When testing for statistical significance despite low statistical power, no differences of DLF were observed between students with IGD and SNUD in logistic regression analyses. Conclusion: The results must be regarded as preliminary and might indicate that students with IGD and SNUD show comparable impairments in DLF. However, higher sample sizes could have led to different results which needs to be investigated in future studies.

Background: Vocational school students exhibit a high prevalence of addictive behaviors. Mobile phone–based prevention programs targeting multiple addictive behaviors and promoting life skills are promising. Tailoring intervention content to participants’ preferences, such as allowing them to choose behavior modules, may increase engagement and efficacy. There is limited understanding of how personal characteristics relate to module choices. Objective: This study examined the prevention needs of German vocational school students as well as their prevention preferences through self-determined module choice in the multibehavior app-based addiction prevention program ready4life. Methods: A 2-arm cluster randomized controlled trial recruited German vocational school students aged ≥16 years. Among 376 classes from 35 schools, ready4life was introduced during a school lesson. Students were invited to download the ready4life app and completed an anonymous screening with individualized risk and competence feedback in the form of a traffic light system. Informed consent was provided by 2568 students. Intervention classes received individual app-based coaching with weekly chat contacts with a conversational agent over 4 months. They could choose 2 of 6 modules: alcohol, tobacco, cannabis, social media and gaming, stress, and social competencies. Control group classes received a link to health behavior information and could access coaching after 12 months. Results: Prevention need was high. For 86.2% (2213/2568), ≥2 risks were reported based on yellow or red traffic light feedback. Within the intervention group, stress (818/1236, 66.2%) and social media and gaming (625/1236, 50.6%) were the most chosen topics, followed by alcohol (360/1236, 29.1%), social competencies (306/1236, 24.8%), tobacco (232/1236, 18.8%), and cannabis (131/1236, 10.6%). Module choices closely aligned with received traffic light feedback among those with 1 or 2 risks. Multilevel regression models showed that women were significantly more likely to choose the stress module (odds ratio [OR] 2.38, 95% CI 1.69-3.33; P<.001); men preferred social media and gaming (OR 0.52, 95% CI 0.40-0.69; P<.001), alcohol (OR 0.50, 95% CI 0.37-0.67; P<.001), and cannabis (OR 0.37, 95% CI 0.21-0.63; P<.001) when holding age, educational track, and prevention need for the corresponding behavior constant. Younger students were significantly more likely to choose the cannabis module (OR 0.81, 95% CI 0.74-0.90; P<.001). Educational track also influenced module choice (eg, those with a lower educational level were more likely to choose alcohol and cannabis, suggesting a positive equity impact). Students’ prevention needs significantly influenced choice of the module (eg, higher alcohol consumption increased the likelihood of choosing the alcohol module; OR 1.31, 95% CI 1.20-1.43; P<.001). Conclusions: Our study confirms vocational school students’ high prevention needs regarding addictive behaviors. Students’ module choices were highly congruent to their demonstrated needs, with most students being interested in the stress module. Module choice also differed by age, gender, and educational track. Trial Registration: German Clinical Trials Register DRKS00022328; https://drks.de/search/en/trial/DRKS00022328 International Registered Report Identifier (IRRID): RR2-10.1024/0939-5911/a000811

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Digital interventions have been successfully used to address addictive behaviors, such as substance use, in adolescents and young adults. However, maintaining engagement remains a challenge for digital substance use interventions. There is limited evidence on the determinants of engagement with multiple behavioral interventions among vocational students. Objective: This paper aims to describe engagement of vocational school students with the app-based addiction prevention program "ready4life" and to analyze student characteristics as potential determinants of engagement. Methods: A two-arm cluster-randomized trial evaluated "ready4life" among German vocational students aged 16+. After downloading the app during class, students completed an anonymous screening and received an individual risks and competencies feedback. Intervention participants (n=1286) received four months individual app-based coaching, with weekly chat contacts with a virtual coach. They were asked to choose two out of six modules: alcohol, tobacco, cannabis, social media/gaming, stress and social competencies that were delivered sequentially in a random order. In addition to the weekly chats, users could self-initiate chat dialogues at any time. Chats included media (videos, images, links), quizzes and contests. Control participants (n=1282) received a link to health behavior information and could access coaching after 12 months. Results: Engagement was low among intervention participants who received their assigned intervention (n=1266; female 44.9%; mean age 19.53, SD 3.57). On average, participants started 4.8 (SD 5.1) and completed 4.3 (SD 5.2) out of 16 weekly in-app chats. Most students (903/1266, 71.3%) completed no self-initiated chats, and 50.2% stopped using the app before week 3. Negative binomial multilevel regression models showed that a significantly higher number of completed weekly dialogues was observed for females (P<.001; IRR 1.55, 95% CI 1.33-1.80), individuals with lower self-efficacy (P=.037; IRR 0.96, 95% CI 0.93-0.998), lower social competencies (P<.001; IRR 0.97, 95% CI 0.95-0.98), and individuals engaging in less addictive behaviors (P<.001; IRR 0.87, 95% CI 0.82-0.93). With respect to specific educational tracks, professionals, technicians, associate professionals and vocational grammar school students had the highest number of completed weekly dialogues. Determinants of completed self-initiated chats and usage time largely aligned with the findings for weekly dialogues. In addition, those with higher perceived stress completed significantly more self-initiated chats (P<.001; IRR 1.19, 95% CI 1.08-1.31). Age and year of education were not significantly associated with any of the engagement parameters. Conclusions: Our study supports the existing evidence that keeping adolescents and young adults engaged is still a major challenge in digital interventions. An important finding was that students with higher needs for support in terms of self-efficacy, social competence, and perceived stress showed higher engagement. In terms of health equity, additional efforts should be made to increase program engagement among males, those with lower levels of education, and those with higher levels of addictive behaviors. Clinical Trial: German Clinical Trials Register (DRKS): DRKS00022328

Introduction: Youths with extreme obesity (body mass index [BMI] ≥40) are at increased risk for physical and mental health impairments. Nevertheless, this patient group has received little attention in research. This study aimed to analyze the pain experience and mental health impairments of youths with extreme obesity compared to those with mild and moderate obesity (BMI = 30–39.9) while also considering potential gender differences. Methods: Cross-sectional data of 431 obese youths (M = 16.6 years; SD = 2.3; range = 13–25 years; 53.1% female) were analyzed. Of these, 159 (36.8%) youths had extreme obesity. Self-reported sociodemographic data, variables related to back or leg pain, depression, and health-related quality of life (HRQoL) were assessed with standardized questionnaires. Data were analyzed with univariate tests and logistic regression models. Results: Youths with extreme obesity reported more pain in the last 4 weeks (p = 0.018), increased pain-related impairments in daily life (p = 0.009), more pain-related days of absence (p = 0.030), higher depression scores (p = 0.030), and reduced HRQoL (p = 0.005) compared to youths with mild and moderate obesity. The association between extreme obesity and pain in the last 4 weeks remained associated after including sociodemographic variables in the regression model. In the subgroup of youth with extreme obesity (n = 159), women (n = 83) reported more pain in the last 4 weeks (p = 0.001), higher depression scores (p < 0.001), and lower HRQoL (p < 0.001) compared to men (n = 76). The association between female gender and pain remained significant in the regression models, even after controlling for sociodemographic variables and depression. Conclusion: These findings highlight the need for standardized assessments of pain and mental health, particularly in the treatment of female youths with extreme obesity. Upcoming studies should analyze the reciprocal interactions of pain and mental health, since both are important barriers to lifestyle changes and weight loss.

Background: In Germany, around 2.250 children and adolescents are diagnosed with cancer each year. Despite generally positive long-term survival rates, many patients must cope with late effects of the disease and its treatment. This highlights the need for a well-structured, long-term approach addressing both physical and mental health issues. Currently, the German healthcare system lacks such comprehensive structures. Our study aims to evaluate the effectiveness of a structured, multidisciplinary long-term approach compared to conventional “treatment as usual” (TAU). Methods: A prospective, multicenter study with ten pediatric university clinics in Germany will be conducted. The cluster-randomization takes place at the clinic level. Children and adolescents who completed their cancer treatment at least five years ago and their parents will be eligible to participate. While the control group (CG) receives TAU, the intervention group (IG) participates in a structured program. This program includes risk-based medical treatment and psychosocial interventions tailored to each patient’s individual needs within a two-month timeframe. The primary outcome is the improvement of self-efficacy. Secondary outcomes are satisfaction with health care, improvement of health-related quality of life (HRQoL), reduction of mental health problems, and improvement of transition readiness. Discussion: This approach has the potential to optimize the health care for individuals who survived cancer during childhood or adolescence. It addresses the challenges of overuse, underuse, and misuse of health care resources. By considering both medical and psychosocial factors and promoting increased self-efficacy, independent from parental involvement, it may facilitate a smoother transition to adult medicine and enhance adherence to lifelong aftercare. If proven successful, this approach will contribute to the integration of multidisciplinary strategies into standard healthcare practice. Trial registration: German Clinical Trials Register DRKS00029269. Registered on December 23, 2022.

Background: Today, the use of digital media is already present at an early stage in the lives of children. Even preschool children can already develop increased digital media use (IDMU). Empirical findings indicate associations of IDMU with several problems in psychosocial development. Therefore, it seems important to identify IDMU early, but there are very few specific approaches for preschool children. The aim of the present survey was to evaluate a newly developed brief screening instrument (based on DSM-5 criteria) named the IDMUQ (an abbreviation for “Increased Digital Media Use Questionnaire”). Methods: We investigated two samples, consisting of 341 parents and of 809 parents, with the IDMUQ, the Short CIUS, and the Parenting Stress Index. Data on screen time and sociodemographic aspects were also collected. We conducted an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) as well as reliability and correlation analyses. Results: The findings of both the EFA and the CFA support a one-dimensional structure for the IDMUQ. The reliability coefficients (Cronbach’s alpha values) were 0.74 and 0.86. We observed first indications of criterion validity for the IDMUQ as well as correlations between parenting stress and IDMU. Conclusions: The results indicate that the IDMUQ, with its four items, is a promising screening tool to measure IDMU in preschool children.

BACKGROUND Vocational school students exhibit a high prevalence of addictive behaviors. Mobile phone–based prevention programs targeting multiple addictive behaviors and promoting life skills are promising. Tailoring intervention content to participants’ preferences, such as allowing them to choose behavior modules, may increase engagement and efficacy. There is limited understanding of how personal characteristics relate to module choices. OBJECTIVE This study examined the prevention needs of German vocational school students as well as their prevention preferences through self-determined module choice in the multibehavior app-based addiction prevention program ready4life. METHODS A 2-arm cluster randomized controlled trial recruited German vocational school students aged ≥16 years. Among 376 classes from 35 schools, ready4life was introduced during a school lesson. Students were invited to download the ready4life app and completed an anonymous screening with individualized risk and competence feedback in the form of a traffic light system. Informed consent was provided by 2568 students. Intervention classes received individual app-based coaching with weekly chat contacts with a conversational agent over 4 months. They could choose 2 of 6 modules: alcohol, tobacco, cannabis, social media and gaming, stress, and social competencies. Control group classes received a link to health behavior information and could access coaching after 12 months. RESULTS Prevention need was high. For 86.2% (2213/2568), ≥2 risks were reported based on yellow or red traffic light feedback. Within the intervention group, stress (818/1236, 66.2%) and social media and gaming (625/1236, 50.6%) were the most chosen topics, followed by alcohol (360/1236, 29.1%), social competencies (306/1236, 24.8%), tobacco (232/1236, 18.8%), and cannabis (131/1236, 10.6%). Module choices closely aligned with received traffic light feedback among those with 1 or 2 risks. Multilevel regression models showed that women were significantly more likely to choose the stress module (odds ratio [OR] 2.38, 95% CI 1.69-3.33; P<.001); men preferred social media and gaming (OR 0.52, 95% CI 0.40-0.69; P<.001), alcohol (OR 0.50, 95% CI 0.37-0.67; P<.001), and cannabis (OR 0.37, 95% CI 0.21-0.63; P<.001) when holding age, educational track, and prevention need for the corresponding behavior constant. Younger students were significantly more likely to choose the cannabis module (OR 0.81, 95% CI 0.74-0.90; P<.001). Educational track also influenced module choice (eg, those with a lower educational level were more likely to choose alcohol and cannabis, suggesting a positive equity impact). Students’ prevention needs significantly influenced choice of the module (eg, higher alcohol consumption increased the likelihood of choosing the alcohol module; OR 1.31, 95% CI 1.20-1.43; P<.001). CONCLUSIONS Our study confirms vocational school students’ high prevention needs regarding addictive behaviors. Students’ module choices were highly congruent to their demonstrated needs, with most students being interested in the stress module. Module choice also differed by age, gender, and educational track. CLINICALTRIAL German Clinical Trials Register DRKS00022328; https://drks.de/search/en/trial/DRKS00022328 INTERNATIONAL REGISTERED REPORT RR2-10.1024/0939-5911/a000811

Background: Intense or problematic media use behavior of parents could serve as a role model for their children’s media use behavior. So far, knowledge is scarce about increased children’s media use (ICMU) and its association with parental stress (PS) and problematic parental media use (PPMU). Methods: ICMU was examined using a modified set of the DSM-5 criteria for Internet Gaming Disorder. PS was assessed via the widely used Parenting Stress Index, and PPMU was assessed using the Short Compulsive Internet Use Scale. A multiple linear regression analysis was conducted to evaluate the links between ICMU, PS, and PPMU. A mediation analysis was performed to examine if PPMU mediated the relationship between PS and ICMU. Results: In sum, 809 parents (M = 36.89 years; SD = 4.87; 81.4% female) of preschool children (average age: 44.75 months, SD = 13.68) participated in the study. ICMU was statistically significantly related to higher age of the parent, greater PPMU, and higher PS. Furthermore, we found that the association between PS and ICMU was partially mediated by PPMU. Conclusions: The results indicate that more pronounced PS and PPMU are associated with ICMU, highlighting the necessity of considering these parental variables when developing early prevention strategies for preschool-age children.

Introduction: Previous studies analyzing friendships with people only known through the Internet mainly focused on quantitative aspects (e.g., the number of online friends or the time spent with them). Little is known about the perceived quality of online compared to real-life friends in individuals with an Internet use disorder (IUD). This study aimed to analyze associations of the increased subjective importance of online friends and IUD by controlling for the perceived real-life social support and comorbid mental disorders. Methods: Based on a general population sample, 192 participants who were screened positive for risky Internet use took part in face-to-face clinical diagnostic interviews. IUD was assessed using the structure of the Munich-Composite International Diagnostic Interview (M-CIDI) and the adapted criteria of Internet gaming disorder in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The number and the increased subjective importance of online compared to real-life friends were assessed with the Online and Real-Life Friends scale (ORLF), real-life social support was assessed with the Berlin Social Support Scales (BSSS), and comorbidity was assessed with the M-CIDI. Data were analyzed with binary regression models. Results: Of 192 participants with risky Internet use, 39 participants (19 men; age M = 29.9, SD = 12.2) fulfilled the criteria of IUD in the last 12 months. IUD was not associated with the number or perceived social support of online friends per se. In multivariate analyses, IUD was associated with increased subjective importance of online friends, independently from comorbid anxiety or mood disorders. However, when controlling for real-life social support, associations of IUD and increased subjective importance of online friends were no longer present. Conclusion: These findings highlight the necessity of therapeutic interventions aimed at strengthening social skills and engaging in real-life relationships in the prevention and therapy of IUD. Due to the small sample size and the cross-sectional analysis, however, further research is needed.