Open Access Open Badges Research article

How often do German children and adolescents show signs of common mental health problems? Results from different methodological approaches – a cross-sectional study

Kristin Sauer1*, Claus Barkmann2, Fionna Klasen2, Monika Bullinger3, Gerd Glaeske1 and Ulrike Ravens-Sieberer2

Author Affiliations

1 Health Policy and Outcomes Research, Division Health Economics, Centre for Social Policy Research, University of Bremen, Mary-Somerville Straße 3, Bremen 28359, Germany

2 Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany

3 Institute and Polyclinic for Medical Psychology, University Clinic Hamburg-Eppendorf, Hamburg, Germany

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BMC Public Health 2014, 14:229  doi:10.1186/1471-2458-14-229

Published: 5 March 2014



Child and adolescent mental health problems are ubiquitous and burdensome. Their impact on functional disability, the high rates of accompanying medical illnesses and the potential to last until adulthood make them a major public health issue. While methodological factors cause variability of the results from epidemiological studies, there is a lack of prevalence rates of mental health problems in children and adolescents according to ICD-10 criteria from nationally representative samples. International findings suggest only a small proportion of children with function impairing mental health problems receive treatment, but information about the health care situation of children and adolescents is scarce. The aim of this epidemiological study was a) to classify symptoms of common mental health problems according to ICD-10 criteria in order to compare the statistical and clinical case definition strategies using a single set of data and b) to report ICD-10 codes from health insurance claims data.


a) Based on a clinical expert rating, questionnaire items were mapped on ICD-10 criteria; data from the Mental Health Module (BELLA study) were analyzed for relevant ICD-10 and cut-off criteria; b) Claims data were analyzed for relevant ICD-10 codes.


According to parent report 7.5% (n = 208) met the ICD-10 criteria of a mild depressive episode and 11% (n = 305) showed symptoms of depression according to cut-off score; Anxiety is reported in 5.6% (n = 156) and 11.6% (n = 323), conduct disorder in 15.2% (n = 373) and 14.6% (n = 357). Self-reported symptoms in 11 to 17 year olds resulted in 15% (n = 279) reporting signs of a mild depression according to ICD-10 criteria (vs. 16.7% (n = 307) based on cut-off) and 10.9% (n = 201) reported symptoms of anxiety (vs. 15.4% (n = 283)). Results from routine data identify 0.9% (n = 1,196) with a depression diagnosis, 3.1% (n = 6,729) with anxiety and 1.4% (n = 3,100) with conduct disorder in outpatient health care.


Statistical and clinical case definition strategies show moderate concordance in depression and conduct disorder in a German national sample. Comparatively, lower rates of children and adolescents with diagnosed mental health problems in the outpatient health care setting support the assumptions that a small number of children and adolescents in need of treatment receive it.