Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz最新文献

Background: Early childhood intervention is intended to systematically network and customise support services, particularly for socio-economically disadvantaged families. The programmes are universal or selective, but the evidence on their effectiveness is limited.

Aims: The aims of this study were to exemplary analyse whether participants in early childhood intervention services had better development than non-participants using the school entry examination (SEE) as well as to discuss to what extent the SEE can be used to assess the impact of early childhood intervention services.

Methods: We analysed three typical offers of early childhood intervention services (family education; Zukunft für Kinder (ZfK); Kita-U) in relation to full vaccination coverage and age-appropriate development at U9. Data from 4579 Düsseldorf first graders were included. Propensity score matching was used to calculate percentage differences (average treatment effect on the treated; ATT) in terms of immunisation coverage and development between comparable intervention and control groups.

Results: All programmes are associated with a slightly increased probability of full vaccination protection (ATT 2.1 for family education; 2.5 for ZfK; 5.3 for Kita-U). Family education is also associated with a slightly higher probability of age-appropriate development (ATT 1.6), while the probability of age-appropriate development is lower for participants in ZfK (-10.1) and Kita‑U (-4.5).

Discussion: The evaluation of early childhood intervention, especially selective services, is a methodological challenge due to confounding and suitable comparison groups. However, the SEE could be a framework for impact analyses under specific conditions.

Background: Little is known about the situation of Ukrainian parents with children up to the age of three who have fled to Germany since Russia's attack on Ukraine. The aim of the National Center for Early Intervention research project is to explore the perspective of this group on their lives in Germany. This analysis focuses on the burdens and resources of the parents and their knowledge and use of support services.

Methods: In 17 interviews (duration approx. one hour each), parents (16 mothers, one father) who had fled from Ukraine to Germany with children up to the age of three were interviewed between October and December 2022, and their answers were qualitatively analyzed using structured content analysis.

Results: The interviewees primarily described the psychological stress caused by war and flight, negative emotions such as feelings of loneliness, sadness and lack of motivation, and obstacles to integration as burdens. Resources were primarily networks of Ukrainian- and Russian-speaking people in Germany as well as personal resources such as self-care skills. Supporting services were generally communicated via electronic media. Services for childcare, language courses, and support with health issues were considered particularly useful. A lack of childcare was the most important reason for not taking up other services.

Discussion: The psychological stress of the interviewees indicates a need for therapy capacities in their native language. Childcare may enable Ukrainians to attend language courses that promote integration. The self-organized networks of the Ukrainian- and Russian-speaking community should be involved in the development of interventions for this target group in a participatory manner from the outset.

Growing up with a mentally ill parent is associated with multiple and far-reaching developmental risks for children. The intergenerational transmission of parental mental disorders is influenced by a variety of risk and protective factors as well as mediating mechanisms both on the part of the parents and children and in the social environment. The influence of parental psychopathology is particularly strong in the first years of life, but also affects development in childhood and adolescence and can have a lifelong negative impact on mental health. Due to the diverse and long-term effects on child development, the identification of transmission factors and the development of prevention and intervention strategies as early as possible are highly relevant in order to reduce the far-reaching negative consequences for the development of the offspring. Possible starting points for this include identified risk and protective factors as well as mediating mechanisms between parental psychopathology and child development. These factors and their effects on early child development are presented in this narrative review based on the current state of research. In addition, research gaps are identified and implications for the development of early interventions are discussed.

Introduction: Around 700,000 children are born in Germany every year. Many mothers are under great pressure and strain due to prevailing role models and social expectations. Up to 15% of mothers in Germany are said to be affected by postpartum depression. The available studies, however, are mainly based on surveys, are older and vary widely in their results. This study brings another data source into play and asks how frequently diagnoses of mental illness are found in mothers after childbirth compared to childless women in the billing data of a large health insurance company.

Methods: A retrospective matched cohort study was conducted with health insurance data from 2017-2022, comparing mothers and childless women with the same age and the same medical and socioeconomic characteristics with regard to depression, exhaustion and burnout, and anxiety and stress disorder outcomes. The modelling was carried out using Poisson regression.

Results: Mothers were less likely than childless women to receive a diagnosis of a mental disorder within five years after childbirth. In the long run, however, the frequency of diagnoses equalised.

Discussion: Becoming a mother does not lead to more diagnoses of mental disorders compared to childless women, at least in the first five years after giving birth. However, the interpretation of the data is difficult. Possible influence of external factors on making the diagnosis is not seen in the data, such as the social expectation of a "happy mother" or a change in the utilisation of medical care due to maternity.

Background: A mentally stressed family environment can pose a risk to the healthy development of infants and young children. It is unclear how widespread psychological distress currently is in the overall population of parents with young children and whether the proportion of parents with psychological distress has increased in recent years of multiple crises. Furthermore, it is unclear to what extent associations between the psychological distress of parents, their parenting skills, and early childhood development persist when a growing number of parents report psychological distress.

Methods: In a nationwide, representative survey, 258 pediatricians documented the development of 7818 infants and toddlers as part of a preventive medical checkup. The children's parents answered questions about their mental health (anxiety and depression) and their parenting skills. The 2022 prevalences were compared with the results of the previous study from 2015.

Results: Taken together, around a fifth (21.5%) of all parents reported moderate or clinically significant psychological distress (2015: 15.7%); parents with psychological distress were significantly more likely to express doubts about their own parenting competencies than parents without psychological distress. Pediatricians documented indications of a regulatory disorder and developmental delay significantly more frequently in children whose parents reported clinically significant psychological distress.

Discussion: The results illustrate the increasing relevance of psychological distress among parents with young children in recent years. The finding that parental psychological distress is associated with developmental abnormality in children once again highlights the need to provide families with targeted support from the outset.

In German-speaking countries, early childhood intervention programmes-known as "Frühe Hilfen"-are generally understood as an overall concept of health promotion measures that particularly target early intervention in pregnancy and early childhood and are primarily aimed at families in stressful life situations. This article provides an overview of early intervention services in Germany, Austria, Switzerland, Liechtenstein and South Tyrol.While various models have been implemented in Germany and continue to co-exist to this day, a standardised model has been established in Austria. South Tyrol and Liechtenstein also orientate themselves on this model. Although there is now also a concept for Switzerland, it has so far only been implemented in individual cantons. Germany, Austria and South Tyrol have so far enshrined the concept in law. In Germany, Austria and Liechtenstein, a national centre has been commissioned to provide ongoing professional and scientific support and quality development. Coordinating units are active at the level of federal states (Germany and Austria) and regions (South Tyrol), although they have different responsibilities in some cases. The core element of voluntary and free outreach family support is provided by a multi-professional team according to the Austrian model and by defined professional groups in Germany (family midwives and family health and paediatric nurses). The available data and results from the accompanying research show that Frühe Hilfen is achieving its goal. Families are relieved and access to specific support services is facilitated. Families who are considered socially or socio-economically disadvantaged can largely be reached.

Background: In Germany, about a fifth of families with young children live under psychosocially stressful conditions that can threaten the healthy development of the child. In order to improve the referral of these families from pediatric practices to early childhood intervention services ("Frühe Hilfen"), the PATH intervention was developed and implemented in Baden-Württemberg. The first step in the referral process is to identify psychosocially stressed families. This study investigated whether the PATH intervention increases the proportion of identified families with psychosocial stress by pediatricians.

Method: In a quasi-experimental study, a total of 293 psychosocially stressed families who were cared for by 29 pediatricians from established pediatric practices were examined. The intervention group (IG) consisted of families with pediatricians from Baden-Württemberg who took part in the PATH intervention. The control group (CG) consisted of families with pediatricians from Bavaria who did not take part in the PATH intervention. Additional qualitative telephone interviews were conducted with 10 pediatricians from the IG and 20 families from the IG with psychosocial stress.

Results: A significantly higher proportion of psychosocially stressed families was identified in the IG than in the CG. The difference was about 20 percentage points and was similar regardless of the family's level of stress.

Discussion: The results show that the PATH intervention improves the identification of psychosocially stressed families by pediatricians. This improved identification of psychosocially stressed families is an important prerequisite for referring families to tailored early childhood intervention services such as those provided by the "Frühe Hilfen".