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Background: Child maltreatment is because of its prevalence and consequences one of the main reasons for global health inequalities and a major public health problem. The medical field offers many opportunities to support affected children. However, there is often very limited awareness concerning child protection beyond a few engaged professionals. The present work aims to survey the state of knowledge and capacities in view of child protection in the medical field and explores health professionals' perspectives on a potential need for action. Methods: From 06/2016 until 02/2021 3,360 health professionals were interviewed. Using quantitative and qualitative items the questionnaire gathered demographic and professional background information as well as assessments regarding the awareness of child protection, capacities in child protection among health professionals and training offers in medicine. Results: The analysis indicated that the topic child protection in medicine is not as present as the high prevalence demands it. The majority (94.0%; n = 3,159) of the probands stated that they need more knowledge and capacities regarding child protection in medicine. More than half of the probands assessed the importance of the issue child protection as low among health professionals. The reasons cited included child protection as being an uncomfortable topic, unwillingness among managers, and a lack of training on the topic. Conclusions: It turned out that there is too little awareness and importance regarding child protection in the medical field. Hence, it is difficult to ensure an adequate care for those affected. Child protection topics should be made mandatory in the training curricula of all health professionals as well as quality standards for prevention and intervention should be implemented in medical institutions. Key messages: Too little attention is paid to child protection in the medical field. More training in child protection and quality standards must be established in the medical field. [ABSTRACT FROM AUTHOR]

Suicide is among the leading causes of death among adolescents and suicide risk is particularly high after discharge from psychiatric inpatient care. Therefore, interventions to reduce suicidal thoughts and behaviours (STBs) among adolescents discharged from psychiatric inpatient care are integral for successful suicide prevention among this group. However, such interventions are scarce. EMIRA aims to close this important gap in mental health services by developing an ecological momentary intervention (i.e., intervention delivered in real-time and within one’s natural setting) consisting of a personalized, automatically triggered crisis support smartphone app to reduce STBs after discharge from psychiatric inpatient care among adolescents aged 14-21 years at risk for suicide. First, we will conduct qualitative interviews with adolescents aged 14-21 years who previously experienced STBs, their parents and health care providers to identify their intervention needs and safety concerns regarding ecological momentary assessment (EMA). Next, we will investigate the short-term variability of STBs and their cognitive and physiological risk factors among adolescents aged 14-21 years using EMA (app-based self-report + wrist worn device). Based on our results and past research we will develop a personalized crisis support smartphone app (mobile safety planning) that is not only self-accessible but starts automatically based on the presence of pre-identified STB risk factors. Finally, we will conduct two consecutive studies to test the feasibility, efficacy and cost-effectiveness of the developed ecological momentary intervention in reducing STBs after discharge from psychiatric inpatient care among adolescents aged 14-21 years at risk for suicide. EMIRA has great potential to close a crucial gap in adolescent mental health services and significantly improve suicide prevention among this group. [ABSTRACT FROM AUTHOR]

Background: Organized sexualized and ritual abuse (ORA), a contentious issue since the 1980s, remains a polarizing topic. Although there is much debate about the existence of this phenomenon, a differentiated perspective is lacking, and no representative study has yet addressed the frequency., Objective: This paper aims to investigate the frequency of ORA in Germany using two representative datasets., Participants and Setting: Data were collected from representative samples of the German population (N = 2522, N = 2515). Participants aged 16 to 96 years (50 and 53 % female) were recruited. They were selected by a random route procedure and asked to fill out a paper-pencil-questionnaire., Methods: The four aspects of ORA (severe sexual violence, perpetrator networks, commercial exploitation, ideology) were assessed based on the definition provided by an expert group. Additionally, in the second survey, a direct yes/no question about the experience of ORA as well as details on perpetrators and offense characteristics were surveyed., Results: Frequency of ORA was low. The direct question on ORA was affirmed by 0.5 % (n = 13), while according to the criteria of the definition, only 0.2 % or less of individuals experienced organized sexualized abuse, and <0.1 % experienced ritual abuse., Conclusion: Although ORA is discussed thoroughly, frequencies in the German population are low. This may be due to inconsistent terminology and operationalization of definitions with lack of precision. However, an intersection of conspiracy beliefs and the topic of ritual violence sheds another light on this issue that should receive more attention., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Etiological theories on the development of psychopathology often incorporate adverse childhood experiences (ACE) as an important contributing factor. Recent studies suggest personality functioning (PF; i.e., stability of the self and interpersonal relationships) as an important transdiagnostic construct that could be useful in better understanding when persons with ACE do (not) develop psychopathological symptoms. A representative sample of N = 2363 was assessed by questionnaires on ACE, PF (Level of Personality Functioning Scale-Brief Form 2.0), and current symptoms of depression, anxiety, and somatization (Brief Symptom Inventory 18). The interaction between ACE and PF on symptoms was investigated using multiple group models and Bayesian structural equation modeling. ACE were positively associated with psychopathology and PF impairments. The interaction effect between ACE and PF explained incremental variance in current symptoms, ranging from 26% for somatization to 49% for depression with the complete model explaining up to 91% of the latent variance in psychopathology. Our findings indicate a diathesis-stress model with PF as a resource or resilience that may buffer against the development of symptoms in the face of adversity. Treatments of depression and anxiety targeting self and interpersonal functioning therefore may lead to improvements in resilience and relapse prevention. [Correction added on 15 March 2023, after first online publication: Level of Personality Functioning Scale-Brief Form has been replaced to Level of Personality Functioning Scale-Brief Form 2.0 ]., (© 2023 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd.)

Large-size studies on the prevalence of female intimate partner violence (IPV) victimization in Germany are rare and partly outdated; representative data on male IPV victimization are lacking altogether. The present survey addresses these gaps. For this study, the instrument of the WHO Multi-country study on women's health and domestic violence has been translated to German and adapted to be used with females and males. A random route procedure in selecting household addresses has been used to gather data on IPV in combination with an omnibus survey on (mental) health issues. A total 2,503 respondents with a minimum age of 14 years have participated (response rate=44.1%). The resulting distribution of age and gender was representative for the German population above the age of 14 years. A total of 57.6% of female participants and 50.8% of male participants have reported victimization by intimate partners during their lifespan; gender distribution differs significantly (Chi 2 =43.43; p<0.001). Out of the different documented subtypes, psychological IPV was most prevalent (53.6% in females, 48.0% in males). Other forms ranged between 15.2% (physical IPV) and 18.6% (sexual IPV) for females, and 5.5% (sexual IPV) and 10.8% (physical IPV) for males. All forms of victimization regularly coincided, both in females and males. Experiencing any IPV was not only significantly associated with female gender, but also with older age, periods of unemployment, poverty, and IPV perpetration. The findings highlight the still much needed global efforts to prevent IPV against women - and in general. They further support previous research in underlining that fighting poverty might also be instrumental in reducing the likelihood of IPV. The discussion further addresses the issues of reciprocity in IPV.

Introduction: Childhood maltreatment (CM) is a developmental risk factor and can negatively influence later psychological functioning, health, and development in the next generation. A comprehensive understanding of the biopsychosocial underpinnings of CM transmission would allow to identify protective factors that could disrupt the intergenerational CM risk cycle. This study examined the consequences of maternal CM and the effects of psychosocial and biological resilience factors on child attachment and stress-regulatory development using a prospective trans -disciplinary approach., Methods: Mother-child dyads ( N = 158) participated shortly after parturition ( t 0 ), after 3 months ( t 1 ), and 12 months later ( t 2 ). Mothers' CM experiences were assessed at t 0 , attachment representation at t 1 and psychosocial risk and social support were assessed at t 1 and t 2 . At t 2 , dyads participated in the Strange Situation Procedure (SSP). Children's attachmen status were classified as organized vs. disorganized, including their level of disorganized behavior, and heart rate (HR) and respiratory sinus arrhythmia (RSA) were recorded as stress response measures of the autonomic nervous system. Maternal caregiving during SSP was assessed using the AMBIANCE scale. Child's single nucleotide polymorphisms rs 2254298 within the oxytocin receptor (OXTR) and rs 2740210 of the oxytocin gene (OXT) were genotyped using DNA isolated from cord blood., Results: Maternal CM experiences (CM+) were significantly associated with an unresolved attachment status, higher perceived stress and more psychological symptoms. These negative effects of CM were attenuated by social support. As expected, maternal unresolved attachment and child disorganized attachment were significantly associated. Maternal caregiving did not mediate the relationship between maternal and child attachment but influenced children's HR and RSA response and disorganized behavior. Moreover, the rs 2254298 genotype of the OXTR gene moderated the stress response of children from mothers with CM. Children carrying the rs 2740210 risk allele of the OXT gene showed more disorganized behavior independent from maternal CM experiences., Conclusion: We replicated and extended existing CM and attachment models by co-examining maternal attachment, social support, and child genetic susceptibility on child attachment and cardiovascular stress regulation. The findings contribute to an extended understanding of risk and resilience factors and enable professionals to target adequate services to parents and children at risk., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Buchheim, Ziegenhain, Kindler, Waller, Gündel, Karabatsiakis and Fegert.)

Background: Adverse childhood experiences (ACEs) increase the risk for mental health problems. However, there is a lack of data targeting the role of ACEs for one of the most prevalent mental health problems in health-care professionals: burnout., Objective: We aimed to assess the relationship between ACEs and the core burnout dimension 'emotional exhaustion' (EE). As health-care professionals have been facing particular challenges during the COVID-19 pandemic, we furthermore aimed to assess the role of COVID-19 associated burden in the interplay between ACEs and EE., Methods: During the first lockdown in Germany, a total of 2500 medical healthcare professionals were questioned in a cross-sectional online survey. Questions targeted, among others, sociodemographics, ACEs, COVID-19-associated problems (e.g. increase of workload, worries about relatives and patients) and emotional exhaustion, measured by the respective dimension of the Maslach Burnout Inventory (MBI)., Results: In German health-care professionals, ACEs were associated with a higher EE score. The number of experienced ACEs was associated with the majority of assessed COVID-19-associated problems. An increasing number of ACEs predicted higher EE scores, controlling for gender. The association between ACEs and EE was mediated significantly by COVID-19-associated problems. These included maladaptive coping strategies such as increased smoking, drinking and use of antidepressants/tranquilizers, feeling less protected by measures of the employee or the state, a greater feeling of being burdened by COVID-19-associated problems and greater exhaustion and sleep problems., Conclusion: Our findings suggest ACEs as significant risk factor for EE in German health-care professionals. The current pandemic means a significant burden that further pronounces this risk., Competing Interests: VC, PB, MJ, KW, MK, EM, FG, CA, SSS, HG and LJB declare that there is no conflict of interest. JMF has received research funding from the EU, DFG (German Research Foundation), BMG (Federal Ministry of Health), BMBF (Federal Ministry of Education and Research), BMFSFJ (Federal Ministry of Family, Senior Citizens, Women and Youth), G-BA Innovationsfonds, several state ministries, State Foundation Baden-Württemberg, Volkswagen Foundation, Porticus Foundation, Diocese of Rottenburg-Stuttgart. Moreover, he received travel grants, honoraria and sponsoring for conferences and medical educational purposes from APK, Deutschlandfunk, DFG, DJI, DKSB, Infectopharm, med update, UNICEF, several universities, professional associations, political foundations, and German federal and state ministries during the last 5 years. Professor Fegert holds no stocks of pharmaceutical companies., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background: There is evidence that health care professionals are uncertain about the legal framework when suspicion of child abuse or neglect is raised. This could result in inconsistent handling of such cases, putting children at risk in further danger. The present study was intended to provide an empirical basis for examining the knowledge of the legal framework among health care professionals., Methods: A survey of child and youth physicians, child surgeons, child and adolescent psychiatrists as well as psychotherapists working in Germany was carried out to obtain information on the general conditions., Results: In all occupational groups, a majority of respondents feel insecure about the application of the legal framework on particular cases. Only a minority can correctly reflect the legal regulations of the Federal Child Protection Act ("Bundeskinderschutzgesetz"). Experience with child abuse cases doubled the odds to correctly understanding legal frameworks. Having attended training courses showed no impact., Conclusion: There is little knowledge of the legal framework in child protection. There is a need to improve training and provide low-threshold counselling services, especially for professionals with little experience in child protection cases., Competing Interests: Interessenkonflikte Prof. Dr. Jörg M. Fegert:• Forschungsförderung von EU, BMG, BMBF, BMFSFJ, DFG, G-BA Innovationsfonds, Länderministerien Baden-Württemberg und Saarland, Landesstiftung Baden-Württemberg, Porticus Stiftung, Evangelische Landeskirche Baden-Württemberg • Reisebeihilfen, Referentenhonorare, Veranstaltungs- und Ausbildungssponsoring von APK, Adenauer- und Ebertstiftung, Deutschlandfunk, DFG, DJI, DKSB, Infectopharm, med update, UNICEF, Fachverbänden, Universitäten sowie Bundes- und Landesministerien • Beratertätigkeit für APK, Bundes- und Landesministerien • Keine Industriegesponserten Vortragsreihen, kein Aktienbesitz, keine Beteiligung an PharmafirmenDie anderen Autoren erklären, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)