title: Risk and protective factors for mental health problems in preschool-aged children: cross-sectional results of the BELLA preschool study.
abstract: BACKGROUND
  Mental health problems (MHPs) in preschoolers are precursors of mental disorders which have shown to be associated with suffering, functional impairment, exposure to stigma and discrimination, as well as enhanced risk of premature death. A better understanding of factors associated with MHPs in preschoolers can facilitate early identification of children at risk and inform prevention programs. This cross-sectional study investigated the association of risk and protective factors with MHPs within a German representative community sample.
  
  
  METHODS
  MHPs were assessed in a sample of 391 preschoolers aged 3-6 years using the Strength and Difficulties Questionnaire (SDQ). The effects of parental MHPs, children's temperament, parental socioeconomic status (SES), social support and perceived self-competence on MHPs were assessed using bivariate and multivariate logistic regression analyses that controlled for sociodemographic characteristics.
  
  
  RESULTS
  Overall, 18.2% of preschoolers were classified as 'borderline or abnormal' on the total difficulties score of the SDQ. Bivariate analyses showed that parental MHPs, children's difficult temperament, and parental low SES increased the likelihood, whereas high perceived parental competence decreased the likelihood of preschool MHPs. In the multivariate analyses, only difficult child temperament remained significantly associated with preschool MHPs when other variables were controlled.
  
  
  CONCLUSIONS
  The results underline the importance of children's difficult temperamental characteristics as a risk factor for mental health in preschoolers and suggest that these may also be an appropriate target for prevention of preschool MHPs. More research on specific aspects of preschool children's temperament, the socioeconomic environment and longitudinal studies on the effects of these in the development of preschool MHPs is needed.
authors.affiliation: Institute and Outpatients Clinic of Medical Psychology, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52 (Building W26), 20246 Hamburg, Germany.
authors.forename: Olga
authors.identifier: 0000-0001-8006-815X
authors.initials: O
authors.lastname: Wlodarczyk
authors.affiliation: Institute and Outpatients Clinic of Medical Psychology, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52 (Building W26), 20246 Hamburg, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Pawils
authors.affiliation: Institute and Outpatients Clinic of Medical Psychology, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52 (Building W26), 20246 Hamburg, Germany.
authors.forename: Franka
authors.initials: F
authors.lastname: Metzner
authors.affiliation: Institute and Outpatients Clinic of Medical Psychology, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52 (Building W26), 20246 Hamburg, Germany.
authors.forename: Levente
authors.initials: L
authors.lastname: Kriston
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Research Division "Child Public Health", Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52 (Building W26), 20246 Hamburg, Germany.
authors.forename: Fionna
authors.initials: F
authors.lastname: Klasen
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Research Division "Child Public Health", Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52 (Building W26), 20246 Hamburg, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Ravens-Sieberer
keywords: Cross-sectional studies; Mental health; Preschool; Protective factor; Risk factor