title: Depressive symptoms of children and adolescents in a German representative sample: results of the BELLA study.
abstract: BACKGROUND
  In Europe, a considerable proportion of children and adolescents is affected by depressive symptoms, impairing their everyday life and social functioning.
  
  
  OBJECTIVE
  The aim of this paper is to provide an overview of the depressive symptoms in children and adolescents in Germany, addressing risk factors, comorbidity, and impact of depressive symptoms on everyday life.
  
  
  METHODS
  In the BELLA study, the mental health module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a representative sample of young people aged 7-17 years was enrolled. Depressiveness, assessed by the CES-DC, as well as other mental health problems were examined in the context of risk and protective factors.
  
  
  RESULTS
  Depressive symptoms showed high prevalence in parent- and self-reports. Higher depression scores were found in those with a high number of psychosocial risks existing in the family, and they decreased as the number of protective factors the children and adolescents had at their disposal increased. Although only half of the boys and girls with high depression scores were regarded as significantly impaired, all of them had a much higher risk for additional mental health problems. Furthermore, their health-related quality of life was limited compared to their peers who had low depression scores.
  
  
  CONCLUSIONS
  To differentiate between clinically significant depression and milder forms, it is necessary to take into account the different perspectives of children and their parents. Prevention and intervention should acknowledge the widespread distribution of depressive symptoms in children and adolescents, the high comorbidity of depressive and other mental health problems and the impact of depression on the aspects of everyday life.
authors.affiliation: Senate Department for Health, Environment and Consumer Protection Berlin, Oranienstr. 106, 10969, Berlin, Germany. susanne.bettge@senguv.verwalt-berlin.de
authors.forename: Susanne
authors.initials: S
authors.lastname: Bettge
authors.forename: Nora
authors.initials: N
authors.lastname: Wille
authors.forename: Claus
authors.initials: C
authors.lastname: Barkmann
authors.forename: Michael
authors.initials: M
authors.lastname: Schulte-Markwort
authors.forename: Ulrike
authors.initials: U
authors.lastname: Ravens-Sieberer
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000296:Adolescent Psychiatry / Q000706:statistics & numerical data; D017677:Age Distribution; D002648:Child; D002665:Child Psychiatry / Q000706:statistics & numerical data; D017281:Cost of Illness; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D005190:Family / Q000523:psychology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D012649:Self Concept; D012650:Self Disclosure; D017678:Sex Distribution; D012944:Social Support