title: How impaired are children and adolescents by mental health problems? Results of the BELLA study.
abstract: BACKGROUND
  The consideration of impairment plays a crucial role in detecting significant mental health problems in children whose symptoms do not meet diagnostic criteria. The assessment of impairment may be particularly relevant when only short screening instruments are applied in epidemiological surveys. Furthermore, differences between childrens' and parents' perceptions of present impairment and impairing symptoms are of interest with respect to treatment-seeking behaviour.
  
  
  OBJECTIVE
  The objectives were to assess parent- and self-reported impairment due to mental health problems in a representative sample of children and adolescents; to describe the characteristics of highly impaired children with normal symptom scores; and to investigate the associations between symptoms in different problem areas and impairment.
  
  
  METHODS
  The mental health module of the German Health Interview and Examination Survey for Children and Adolescents (the BELLA study) examined mental health in a representative sub-sample of 2,863 families with children aged 7-17. Self-reported and parent-reported symptoms of mental health problems and associated impairment were identified by the extended version of the strengths and difficulties questionnaire (SDQ) in children 11 years and older.
  
  
  RESULTS
  Considerable levels of distress and functional impairment were found with 14.1% of the boys and 9.9% of the girls being severely impaired according to the parental reports. However, self-reported data shows a reversed gender-difference as well as lower levels of severe impairment (6.1% in boys; 10.0% in girls). Six percent of the sampled children suffer from pronounced impairment due to mental health problems but were not detected by screening for overall symptoms. Childrens' and parents' reports differed in regard to the association between reported symptom scores and associated impairment with children reporting higher impairment due to emotional problems.
  
  
  CONCLUSIONS
  The assessment of impairment caused by mental health problems provides important information beyond the knowledge of symptoms and helps to identify an otherwise undetected high risk group. In the assessment of impairment, gender-specific issues have to be taken into account. Regarding the systematic differences between childrens' and parents' reports in the assessment of impairment, the child's perspective should be given special attention.
authors.affiliation: Department of Psychosomatics in Children and Adolescents, Centre for Obstetrics and Paediatrics, University Clinic Hamburg-Eppendorf, Martinistrasse 52, W29, 20246, Hamburg, Germany. n.wille@uke.uni-hamburg.de
authors.forename: Nora
authors.initials: N
authors.lastname: Wille
authors.forename: Susanne
authors.initials: S
authors.lastname: Bettge
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Wittchen
authors.forename: Ulrike
authors.initials: U
authors.lastname: Ravens-Sieberer
mesh_terms: D000293:Adolescent; D000296:Adolescent Psychiatry / Q000706:statistics & numerical data; D000342:Affective Symptoms / Q000453:epidemiology / Q000523:psychology; D001288:Attention; D002648:Child; D002665:Child Psychiatry / Q000706:statistics & numerical data; D017281:Cost of Illness; D005190:Family / Q000523:psychology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology*; D016017:Odds Ratio; D010290:Parents / Q000523:psychology; D015995:Prevalence; D011594:Psychometrics / Q000379:methods; D011788:Quality of Life / Q000523:psychology*; D012650:Self Disclosure; D012720:Severity of Illness Index; D017678:Sex Distribution; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology*; D011795:Surveys and Questionnaires