The impact of parents' stress on parents' and young childrens' mental health-Short- and long-term effects of risk and resilience factors in families with children aged 0-3 in a representative sample.

Stress in parents has a significant impact on parenting and infant's development. However, few studies have examined cross-sectional and longitudinal links on risk and resilience of burdened families. Thus, this study aimed to investigate subjective risk and resilience factors on family well-being. Data stem from the 2015 nationwide study "Children in Germany" ("Kinder in Deutschland" - KiD 0-3). Parents of children aged zero to 3 years (N = 8.063) were recruited from random probability-sampled paediatric clinics (n = 271) across Germany. Risk and resilience variables such as parents' perceived stress (PSS-4), competence, isolation and attachment (PSI), as well as parental inner anger (items from CAP), relationship quality (DAS-4) and the child's negative emotionality (items from SGKS) were assessed at baseline in addition to demographic variables to predict parents' mental health (PHQ-4) and negative emotionality of the child at baseline (T1) and in the 2-year follow-up (T2) using linear regression models. At baseline, parents' mental health was predicted by inner anger, the child's negative emotionality and being a single parent (R2 = 45.1%) at baseline, but only by parenting competence at the two-year-follow-up (R2 = 25.1%). The child's negative emotionality was predicted (R2 = 27.5%) by the child's age, and parental inner anger and competence, attachment, perceived stress, mental health as well as education background. At two-year-follow-up, the child's age, single parenthood, social welfare benefit, child's negative emotionality at baseline, relationship quality and competence were significant predictor variables (R2 = 22.8%). This study highlights the impact of specific risk and resilience factors not only on parents' mental health but also the child's negative emotionality in the short and long-term in early childhood. Universal, but also selective prevention programs should increase parents' resilience (e.g., focusing on self-efficacy, competence, coping strategies).

Formation of mineral-associated organic matter in temperate soils is primarily controlled by mineral type and modified by land use and management intensity.

Formation of mineral-associated organic matter (MAOM) supports the accumulation and stabilization of carbon (C) in soil, and thus, is a key factor in the global C cycle. Little is known about the interplay of mineral type, land use and management intensity in MAOM formation, especially on subdecadal time scales. We exposed mineral containers with goethite or illite, the most abundant iron oxide and phyllosilicate clay in temperate soils, for 5 years in topsoils of 150 forest and 150 grassland sites in three regions across Germany. Results show that irrespective of land use and management intensity, more C accumulated on goethite than illite (on average 0.23 ± 0.10 and 0.06 ± 0.03 mg m-2 mineral surface respectively). Carbon accumulation across regions was consistently higher in coniferous forests than in deciduous forests and grasslands. Structural equation models further showed that thinning and harvesting reduced MAOM formation in forests. Formation of MAOM in grasslands was not affected by grazing. Fertilization had opposite effects on MAOM formation, with the positive effect being mediated by enhanced plant productivity and the negative effect by reduced plant species richness. This highlights the caveat of applying fertilizers as a strategy to increase soil C stocks in temperate grasslands. Overall, we demonstrate that the rate and amount of MAOM formation in soil is primarily driven by mineral type, and can be modulated by land use and management intensity even on subdecadal time scales. Our results suggest that temperate soils dominated by oxides have a higher capacity to accumulate and store C than those dominated by phyllosilicate clays, even under circumneutral pH conditions. Therefore, adopting land use and management practices that increase C inputs into oxide-rich soils that are under their capacity to store C may offer great potential to enhance near-term soil C sequestration.

[Stressful Living Conditions in Nuclear, Single Parent and Stepfamilies and Use of Prevention Services. Findings of Two Representative German Studies]. / Belastungslagen von Alleinerziehenden-, Stief- und Kernfamilien Inanspruchnahme von Unterstützungsangeboten. Befunde aus zwei repräsentativen deutschen Studien.

AIM OF THE STUDY: Comparison of (stressful) living conditions and use of universal, selective and indicated prevention services in nuclear, single parent and stepfamilies with young children. METHODS: Using two representative German surveys of mothers with children aged 0-3 years (KiD 0-3 2015, n=6,671, and AID:A 2019, n=1,501), mothers' reported burden and the use of various prevention services in different family types were examined descriptively and with Chi²-tests. RESULTS: Overall, single parent families and, to some extent, stepfamilies showed increased socioeconomic stress compared to nuclear families (e. g., young motherhood, higher poverty risk). In particular, universal prevention services (e. g., prenatal classes, parent-child courses) were used less frequently by single parent families, while selective and indicated services such as family or child guidance counselling services and offers of youth welfare agencies were used more frequently. CONCLUSION: Increased socioeconomic stress suggests a higher need for support among single parents compared to nuclear families. Universal group offers are possibly not sufficient to meet these needs, whereas selective individual counselling offers such as pregnancy and child guidance counseling are used more frequently by single parent families and stepfamilies compared to nuclear families. There seems to be a lack of (group) offers tailored to single parent families - particularly in the first developmental phase of a child's life.

[Families with infants and toddlers in the COVID-19 pandemic: parental stress and child development considering social class]. / Familien mit Säuglingen und Kleinkindern in der COVID-19-Pandemie: Belastungserleben und Entwicklungsauffälligkeiten unter Berücksichtigung der sozialen Lage.

INTRODUCTION: It is now well established empirically that families and children who could not attend educational and childcare institutions during the COVID-19 pandemic experienced disadvantages. This is particularly true for families in poverty. However, little is known about the situation of families with young children. The aim of the paper is to investigate (1) to what extent families with infants and toddlers also experienced their situation during the pandemic as stressful, (2) whether there were differences depending on social class, (3) how the pandemic affected the healthy development of infants and toddlers, and (4) to what extent class-related differences can also be identified in this. METHODS: The German National Centre for Early Prevention conducted a nationally representative survey of families with children of age 0 to 3 years in April to December 2022, "Kinder in Deutschland 0­3 2022" (N = 7821). The KiD 0­3 study combines a parent survey on family psychosocial burden and resources with pediatric documentation of child development. RESULTS: Parents with very young children experienced their situation in the COVID-19 pandemic as stressful. A clear difference depending on social class emerged. Both from the parents' perspective and in pediatric judgment, the pandemic had a negative impact on social and affective development even in young children. These effects were more pronounced in children from families experiencing poverty than in children from families not receiving basic government benefits. DISCUSSION: In order to mitigate the psychosocial consequences of the COVID-19 pandemic for families and to improve children's chances of growing up in a healthy way that promotes their development, it is necessary to support families in need without stigmatization.

[Family stressors on young children's emotional development]. / Familiale Belastungsfaktoren für die emotionale Entwicklung junger Kinder.

BACKGROUND: Adverse childhood experiences (ACE) have been pointed out as risk factors for physical and mental health, with consequences extending from childhood into adulthood. Based on research regarding the effects of selected ACE as well as the accumulation of ACE, this article investigates how different types of family stressors are linked to children's negative emotionality in infancy and early childhood. METHODS: Data are from the KiD 0-3 study (N = 5583) and the follow-up of a subsample after 2 years (n = 681). Based on 14 stress factors, we distinguish families with no/little stressors, socioeconomic stressors, parenting stressors, and multiple stressors. RESULTS: Children in multiply stressed families have the highest risk of high negative emotionality (compared to unstressed families: Odds Ratios [OR] ranging from 13.00 to 6.81), controlling for demographic characteristics, child-related stress factors (e.g., excessive crying), and caregiver childhood stress. Children in families primarily characterized by parenting stress also showed a significantly increased risk of high negative emotionality (OR ranging from 8.31 to 6.95), whereas this did not hold for children from socioeconomically stressed families (without parenting stress) compared to those from unstressed families. Longitudinal analyses of the follow-up subsample showed that changes in the number of stressors were also associated with parallel changes in children's negative emotionality. DISCUSSION: These results confirm findings from international research on ACE in Germany and for early childhood. They underline the importance of a well-developed early intervention system.

How are families in Germany doing in 2022? Study protocol of a nationally representative, cross-sectional study of parents with children aged 0-3 years.

BACKGROUND: In order for Early Childhood Intervention (ECI) to be effective, data-based information on families' resources, burden and current use of support services for families with young children, as well as on children's health and development is needed. The study Kinder in Deutschland [Children in Germany]-KiD 0-3 2022 aims at providing these data to help us understand families' situation and needs in Germany now, including families' experience of the COVID-19 pandemic. METHOD: The study will recruit up to 300 pediatricians who will invite parents of children aged up to 48 months to participate in the study during a well-child visit. Parents (goal N = 8,000) will complete an online-questionnaire with their own web-enabled device. Pediatricians will complete a short questionnaire about each participating family. The questionnaires cover family psychosocial burden and resources, child health and development, use of family support services, as well as the families' experiences of the COVID-19 pandemic. Data will be analyzed to assess patterns of families´ psychosocial burdens and resources, use of support services for families with young children, and children´s health and development. Concordance between parent and pediatrician report will be assessed and comparisons with the predecessor study of 2015 will be drawn. DISSEMINATION: Findings will be disseminated through scientific conferences, open access peer-reviewed journals, and dissemination channels of the National Centre for Early Prevention. DISCUSSION: The present study will provide parent and pediatrician reports on how families with young children are doing in Germany. These data will be used to inform Germany's early childhood intervention (ECI) program ("Frühe Hilfen") on current needs of families with young children.

[Families with Increased Parenting Stress and Conflict Potential: a Target Group for Psychosocial Support Services?] / Familien mit erhöhtem elterlichen Stress und Konfliktpotential: Eine Zielgruppe für psychosoziale Unterstützungsangebote?

STUDY AIM: Psychosocial stress can complicate the first phase of life for young families. One group that has received little attention so far are families with increased parental stress and conflict potential. This paper aims to 1) classify knowledge and use of support services for families with increased parental stress and conflict potential and 2) describe the psychosocial characteristics and parenting behaviours of these families. METHODS: For this purpose, data from a representative cross-sectional study in 2015 with n=7 549 families as well as the follow-up study with n=905 families were analyzed. Parents who took their child to a pediatrician's office for a screening examination (U3-U7a) completed a written questionnaire. Knowledge and use of services were assessed using four pre-defined stress groups (unstressed, socioeconomically stressed, with parental stress and conflict potential, and highly burdened). RESULTS: Families with increased parental stress and conflict potential are less likely to receive support offers. Despite high knowledge of selective prevention services, they use these offers less frequently than socioeconomically or highly stressed families. They are more likely to report dysfunctional parenting behaviors. CONCLUSION: This raises the question of whether families with increased parental stress and conflict potential receive too little support because they have no clearly visible need for help or whether they are adequately provided for due to the high socioeconomic resources, service knowledge, and use of universal medical and family education services. The results provide important information for the care of families in various stressful situations and contribute to the assessment of the need for support.

[An urban-rural comparison of family stress and early childhood intervention: Data linkage between two cross-sectional studies]. / Ein Stadt-Land-Vergleich familialer Belastungen und Früher Hilfen.

An urban-rural comparison of family stress and early childhood intervention: Data linkage between two cross-sectional studies Abstract. Background: So far, there is insufficient information about where in Germany which families are reached by home-visiting programs and how well. One example is the provision of home-visiting program by health service professionals (LaB) in early childhood intervention. Research questions: Are there urban-rural differences in psychosocial stress among families? What differences exist in terms of expanding support services, receiving a service, and using the offered LaB? Methods: Data from a representative family survey on psychosocial stress characteristics and the use of services, and a nationwide survey of professionals on the development and expansion of early childhood intervention at the community level were linked. Analyses included descriptive statistics and regression models. Results: Most psychosocial stress characteristics were reported with similar rates in rural and urban areas. Although the LaB program is more widespread in urban regions, it was more likely to be used in rural regions when offered. LaB was more likely to be used by families with migration background, with signs of depression or anxiety of parents, and with a child with perinatal adversities, and less likely when there was a need for expansion of this service. Conclusions: The increased use in rural areas could be due to the fact that there are long distances to few centralized services. Therefore, the outreach character of the LaB program is appreciated, especially among less mobile families.

Long-term effects of targeted prevention programmes for families with young children: A population-based study on parenting stress and children's negative emotionality.

BACKGROUND: Many prevention programmes for families focus parental adversities and adverse childhood experiences. Effects of such programmes are often examined in clinical trials; there is less research on effects under naturalistic conditions. The aim of this study was to examine the longitudinal association between parenting stress and child's negative emotionality, its modification through targeted prevention programmes, and to investigate the effects in the general population. METHODS: Data were taken from a sample of n = 903 families with infants (mean age: 13.3 months) who participated in a baseline study (T1) and a follow-up study (T2) 2 years later. The survey included parental self-report measurements on parenting stress and child's negative emotionality (T1 and T2 each) and targeted prevention programmes (T1 only). An autoregressive cross-lagged panel design was used to analyse the association of parenting stress and the child's negative emotionality, including use of targeted prevention programmes as moderator. We also tested if targeted prevention programmes can reduce parenting stress or child's negative emotionality using Propensity Score Matching (PSM). RESULTS: Parenting stress at T1 affected children's negative emotionality at T2, but children's negative emotionality at T1 did not affect parenting stress at T2. When targeted prevention was included as moderator, the correlation disappeared among programme users. With PSM, there was no direct effect on parenting stress or child's negative emotionality. But a subsample of parents with high parenting stress at T1 who used targeted prevention at T1 reported less child's negative emotionality problems at T2 than parents who scored high in parenting stress but did not receive targeted prevention at T1. CONCLUSION: Results suggest that the spillover from parenting stress to child's negative emotionality may be modified by prevention. Prevention programmes may help to build resources and have a direct positive effect on the child, especially for parents with high parenting stress.

Characteristics and patterns of health and social service use by families with babies and toddlers in Germany.

OBJECTIVES: In the field of family health, cross-sectoral collaboration is promoted to reach vulnerable groups and overcome the prevention dilemma. To understand the extent to which these measures counteract the effects of social inequality with respect to health and social service uptake, we aim to identify socio-economic, health-related and psychosocial characteristics and patterns that are associated with the (non-)use of services. STUDY DESIGN: This was a German representative cross-sectional study of 6860 mothers with a child younger than 48 months who answered the written questionnaire during child developmental examinations at paediatric practices in 2015. METHODS: Associations were measured using logistic regression, and characteristics of user patterns were analysed using latent class analysis. RESULTS: Mothers using universal services were less likely to report psychosocial stress and had more likely more socio-economic resources than mothers who did not use these services. The selective services pregnancy counselling (18.2%) were predominantly used by mothers who considered abortion during pregnancy (Odds Ratio [OR] = 3.9), mothers who received social welfare benefits (OR = 2.4), single parents (OR = 1.6) and mothers without social support (OR = 1.5). Four patterns of service use were identified: multi-service users (5.6%), low-service users (22.5%), medical service users (30.5%) and medical and social service users (41.6%). Families with less socio-economic resources were found in both the low-service group and the multi-service group; multi-users were more likely to have children with adverse perinatal characteristics and parenting stress. CONCLUSION: We discuss whether low-service users are hard to reach, whereas multi-users are difficult to supply. Overall, there is a need to strengthen early psychosocial support.

Risk factors for child abuse, neglect and exposure to intimate partner violence in early childhood: Findings in a representative cross-sectional sample in Germany.

BACKGROUND: The KiD 0-3 national main study is a cross-sectional study on adversity in early childhood and parental access to support services, conducted as part of a long-term policy program for early intervention services in Germany. OBJECTIVE: To identify risk factors for child abuse, neglect and exposure to intimate partner violence (IPV) and investigate if parental use of early intervention programs or contact to child welfare services was associated with reported child maltreatment. PARTICIPANTS AND SETTING: 8063 families with infants and toddlers participated in the survey. Parents answered a written questionnaire during mandatory health checks for the child. The sampling was based on a regionally clustered model of pediatricians' practices. METHODS: An automatic variable selection process was used to test risk factors and logistic regression models were employed for each outcome. RESULTS: Significant risk factors (p < 0.05) for child abuse (1.91 %) were child age, IPV and parental stress. Neglect (0.83 %) was associated with couple distress, adverse childhood experiences, young maternal age, cramped housing, and migration history. IPV (2.98 %) was associated with child age, couple distress, depression/anxiety, harsh punishment, adverse childhood experiences, young maternal age, and poverty. Parents were more likely to use selective prevention programs in cases of child abuse and exposure to IPV. CONCLUSION: Child abuse is mainly associated with proximal risk factors and neglect with distal factors. Exposure to IPV violence is associated with child abuse as well as with an accumulation of adversities. The association between service use and child maltreatment is discussed.

Self-Reported Psychosocial Stress in Parents With Small Children.

BACKGROUND: Psychosocial stress in early childhood can impair children's health and development. Data on the prevalence of psychosocial stress in families with infants and toddlers in Germany are lacking. Such data could be used to determine the need for prevention and to plan the appropriate preventive measures. METHODS: In 2015, a representative cross-sectional study called Kinder in Deutschland- KiD 0-3 was conducted by questionnaire in pediatricians' practices across Germany. Parents taking their children to the U3-U7a child development checks were asked to self-report information about stress in their families. The data were analyzed with descriptive statistics and chi-square tests. RESULTS: Data from 7549 families went into the analysis. Stressful situations commonly reported by the parents included unplanned pregnancy (21.3%), parenthoodrelated stress (e.g., self-doubt as to parenting competence, 29.6%), and lack of familial and social support for problems and questions arising in relation to the child, as well as for temporary child care (19.7%). Most types of psychosocial stress varied as a function of the child's age group, as categorized by the particular examination for which the child was presenting at the time of the survey (U3-U7a). Couple distress, lack of social support, signs of depression or anxiety symptoms, or inner anger were more commonly reported by parents attending the later examina - tions. Such problems could be addressed by supportive measures (e.g., parent counseling, early child intervention). CONCLUSION: Psychosocial stress affects a large percentage of the parents of small children. A large proportion of parents of small children suffer from psychosocial stress. This should be monitored for accumulation and stability across child development checks and addressed as appropriate. Family practitioners and pediatricians are important partners for effective cooperation between the social system and the health-care system, and for the provision of preventive measures where appropriate.

Who gets lost and why: A representative cross-sectional survey on sociodemographic and vestibular determinants of wayfinding strategies.

When we think of our family and friends, we probably know someone who is good at finding their way and someone else that easily gets lost. We still know little about the biological and environmental factors that influence our navigational ability. Here, we investigated the frequency and sociodemographic determinants of wayfinding and their association with vestibular function in a representative cross-sectional sample (N = 783) of the adult German-speaking population. Wayfinding was assessed using the Wayfinding Strategy Scale, a self-report scale that produces two scores for each participant representing to what degree they rely on route-based or orientation (map-based) strategies. We were interested in the following research questions: (1) the frequency and determinants of wayfinding strategies in a population-based representative sample, (2) the relationship between vestibular function and strategy choice and (3) how sociodemographic factors influence general wayfinding ability as measured using a combined score from both strategy scores. Our linear regression models showed that being male, having a higher education, higher age and lower regional urbanization increased orientation strategy scores. Vertigo/dizziness reduced the scores of both the orientation and the route strategies. Using a novel approach, we grouped participants by their combined strategy scores in a multinomial regression model, to see whether individuals prefer one strategy over the other. The majority of individuals reported using either both or no strategy, instead of preferring one strategy over the other. Young age and reduced vestibular function were indicative of using no strategy. In summary, wayfinding ability depends on both biological and environmental factors; all sociodemographic factors except income. Over a third of the population, predominantly under the age of 35, does not successfully use either strategy. This represents a change in our wayfinding skills, which may result from the technological advances in navigational aids over the last few decades.

Correction to: barriers and facilitators for the management of vertigo: a qualitative study with primary care providers.

After publication of the original article [1] it was brought to the authors' attention that a sentence was missing in the acknowledgement section. The full acknowledgement is included in this Correction article.

Barriers and facilitators for the management of vertigo: a qualitative study with primary care providers.

BACKGROUND: Although the management of patients presenting with vertigo and dizziness in primary care has been reported to be inefficient, little is known about the primary care providers' (PCPs) perspectives, needs, and attitudes regarding vertigo management. The objective of this study was to understand which challenges and barriers PCPs see when diagnosing and treating patients presenting with vertigo or dizziness. Specifically, we wanted to identify facilitators and barriers of successful guideline implementation in order to inform the development of targeted interventions. METHODS: A theory-based interview structure was developed based on the implementation theory of capability, opportunity, and motivation for behaviour change (COM-B) using questions based on constructs from the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR). Transcripts of the semi-structured interviews were analysed using directed content analysis. The pathways through which guideline characteristics and supportive interventions affect the relationship between the PCPs' perceived capability, opportunity, and motivation as well as their practice of managing vertigo patients were graphically presented using the COM-B model structure. RESULTS: Twelve PCPs from Bavaria in Southern Germany participated in semi-structured interviews. Diagnostics posed the biggest challenge in vertigo management to the PCPs. Requirements for an acceptable guideline were stakeholder involvement in the development process, clarity of presentation, and high applicability. Guideline implementation might be effectively supported through educational meetings and sustained by organisational interventions. CONCLUSIONS: From the PCPs' perspective, both guideline characteristics and interventions supporting guideline implementation may help resolve challenges in vertigo management in primary care. These results should be used to guide future interventions in the primary care setting to ensure successful and targeted patient management.

Cost burden of type 2 diabetes in Germany: results from the population-based KORA studies.

OBJECTIVE: To examine the impact of type 2 diabetes on direct and indirect costs and to describe the effect of relevant diabetes-related factors, such as type of treatment or glycaemic control on direct costs. DESIGN: Bottom-up excess cost analysis from a societal perspective based on population-based survey data. PARTICIPANTS: 9160 observations from 6803 individuals aged 31-96 years (9.6% with type 2 diabetes) from the population-based KORA (Cooperative Health Research in the Region of Augsburg) studies in Southern Germany. OUTCOME MEASURES: Healthcare usage, productivity losses, and resulting direct and indirect costs. METHODS: Information on diabetes status, biomedical/sociodemographic variables, medical history and on healthcare usage and productivity losses was assessed in standardised interviews and examinations. Healthcare usage and productivity losses were costed with reference to unit prices and excess costs of type 2 diabetes were calculated using generalised linear models. RESULTS: Individuals with type 2 diabetes had 1.81 (95% CI 1.56 to 2.11) times higher direct (€3352 vs €1849) and 2.07 (1.51 to 2.84) times higher indirect (€4103 vs €1981) annual costs than those without diabetes. Cardiovascular complications, a long diabetes duration and treatment with insulin were significantly associated with increased direct costs; however, glycaemic control was only weakly insignificantly associated with costs. CONCLUSIONS: This study illustrates the substantial direct and indirect societal cost burden of type 2 diabetes in Germany. Strong effort is needed to optimise care to avoid progression of the disease and costly complications.