Background: Children and adolescents who present to child and adolescent psychiatric emergency departments show a variety of reasons for their presentations. Suicidality, in particular suicidal thoughts and suicide attempts, as well as non-suicidal self-injury (NSSI) play a large and important role. In this context, inpatient admissions frequently serve as crisis intervention.Methods: In this study, face-to-face emergency presentations to the emergency department at our Clinic of Child and Adolescent Psychiatry (CAP) were analyzed over the years 2014-2018, the 4th quarter (October-December) of each year. Data from 902 emergency presentations were evaluated, primarily with regard to suicidal thoughts, suicide attempts, and NSSI as reasons for presentation.Results: Data demonstrated that the number of emergency presentations increased in general and especially for suicidal thoughts and NSSI as reasons for presentation. In addition, suicidal thoughts, suicide attempts, and NSSI as reasons for emergency presentation were more likely to result in crisis-related inpatient admissions. Furthermore, reporting suicide attempts at emergency presentation was associated with longer inpatient stays. Finally, cases with multiple diagnoses increased independent of the general increase in emergency presentations.Conclusion: The increase of utilization of clinics with CAP outpatient emergency patients and following admissions to the inpatient units for crisis intervention poses a major challenge for the future. It is important to prepare for the assessment and treatment of suicidality, which is of extraordinary importance in the care of emergency patients.

Since the first COVID-19 case was diagnosed in Germany, various lockdown measures were imposed across the country that likely had a large impact on psychological well-being. In the current study, we investigate depressive symptoms as depression is a leading contributor to the global burden of disease and potentially life-threatening. This study reports on a dataset that was collected between April 8 and June 1 2020 through an online survey in several German states. More than 2000 individuals took part in the survey measuring depressive symptoms (as defined in ICD-10). Similar to recent observations from Italy and China, severe depressive symptoms reported were relatively high. Especially younger adults and females reported more severe symptoms compared to other groups. In conclusion, we need to prepare for increased need of psychological services, availability and accessibility already parallel with imposing restrictive measures.

After the first COVID-19 case was diagnosed in Germany, various measures limiting contact between people were introduced across the country. The implementation of these measures varied between jurisdictions and potentially had a negative impact on the psychological well-being of many people. However, the prevalence, severity, and type of symptoms of psychological burden has not been documented in detail. In the current study, we analysed various self-reported symptoms of psychological burden in a German sample. The dataset was collected between April 8th and June 1st, 2020, through an online survey measuring psychological burden using the ICD-10-symptom rating scale. More than 2,000 individuals responded to the survey, with a total of 1,459 complete datasets. Data was then sampled to compare (1) the new data to an existing demographically comparable reference dataset including a total of 2,512 participants who did not undergo any kind of contact restrictions or other pandemic measurements, and (2) psychological burden in two different German states. In line with recent observations from Germany, Italy, China, Austria and Turkey, we found a high prevalence of depressive symptoms in comparison to the reference sample. Furthermore, we found a high prevalence of eating disorder and compulsion symptoms. Especially younger adults and women reported a higher symptom severity compared to other groups during our measurement period. However, no difference between the two states in psychological burden was found.

Background: Adolescents presenting in a child and adolescent psychiatric emergency service show various psychiatric disturbances, most commonly suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI). It was postulated that especially disturbed emotion regulation contributes to self-injurious behavior of young people. This study aims to investigate the relevance of emotional reactivity (ER), as part of emotion regulation, during an acute crisis, how it relates to self-injurious behavior reinforcement and how a family as well as peers' history of self-injurious behavior are associated with self-injurious behavior of presenting adolescents. Additionally, crisis-triggering background factors were evaluated from the perspective of patients and their caregivers.Methods: A consecutive sample of 86 adolescents aged 11–18 years presenting to the emergency outpatient department due to self-injurious thoughts and behavior received a pretreatment psychiatric evaluation. Among other psychometric measures and structured clinical interviews, ER was measured via the Emotion Reactivity Scale (ERS). Family-related aspects were collected both through evaluation of history and through questionnaires filled in by custodians or parents.Results: Data analysis revealed that suicidal ideation was significantly related to family history with self-injurious behavior in comparison with a family background without such a history. A significant positive correlation was apparent between the ERS sensitivity score and occurrence of NSSI within the past year. A relationship between the ERS and distinct types of reinforcement as a motivation factor for NSSI was found. Post-hoc tests revealed a significant difference between boys and girls when no positive peers' history is present with boys having lower ERS scores than girls, but no difference when both groups had friends engaging in self-injurious behavior. There was only moderate agreement between parents and their children in naming reasons for the current crisis involving NSSI.Conclusion: Emotional regulation, especially ER, has an influence on patients' acute psychiatric symptomatology and when experiencing an acute crisis should be brought into focus early at psychiatric assessment. A history of self-injurious behavior taken from patient's family members and close circle of friends and agreement on reasons for the crisis should be routinely included in the exploration of a patient presenting with self-injurious behavior.

Background Internalizing problems are common in young children, often persist into adulthood, and increase the likelihood for subsequent psychiatric disorders. Problematic attachment, parental mental health problems, and stress are risk factors for the development of internalizing problems. COVID-19 lockdown measures have resulted in additional parental burden and especially their impact on preschool children has rarely been investigated as of now. The current study examined the impact of sustained preschool attendance, parental stress, and parental mental health on internalizing and externalizing problems during COVID-19 lockdown measures in a sample of preschool children in Germany. Methods and findings N = 128 parents of preschool children filled out a one-time online survey about children’s internalizing problems, externalizing problems, and attachment for three time points: before a nation-wide lockdown (T1), during the most difficult time of the lockdown (T2) and after the lockdown (T3). Additionally, parents answered questions about their own depressive and anxious symptomatology for the three time points and parental stress for T1 and T2. Linear-mixed effect models were computed to predict children’s internalizing / externalizing behavior. Preschool children showed a significant increase in internalizing and externalizing problems over time, highest at T2 with small decreases at T3. Parental depressive and anxious symptomatology increased significantly from T1 to T2, but also remained high at T3. Parental stress levels were comparable to community samples at T1, but attained average values reported for at-risk families at T2. Linear-mixed effect models identified higher parental stress, parental anxiety, attachment problems, parental education, and less preschool attendance as significant predictors for internalizing and externalizing problems in preschoolers with more specific associations shown in separate models. A limitation is the retrospective assessment for the times T1 and T2. Conclusions Preschool children’s mental health is strongly and negatively influenced by the ongoing COVID-19 pandemic and its lockdown measures. Sustained preschool attendance may serve as a protective factor.