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BACKGROUND: Even among minors, the use of psychotropic substances is widespread in Europe. Data on the use of tobacco, alcohol and cannabis are regularly reported in Germany, but data on problematic use are lacking. In the present study, established screening instruments were used to investigate the prevalence of problematic use of cigarettes, alcohol and cannabis among children and adolescents. METHODS: A survey that was designed to be representative was conducted across Germany in a sample of 4001 persons aged 12-17. The survey consisted of established screening instruments for problematic consumption patterns and related psychosocial aspects. Prevalences were estimated, and bivariate and multivariate associated characteristics were studied. RESULTS: Among 12- to 17-year-olds in Germany, the prevalence values (with 95% confidence intervals) of problematic use were: for cigarettes, 0.5% [0.3; 0.7]; for alcohol, 11.3% [10.3; 12.3]; and for cannabis, 0.5% [0.3; 0.7]. For the problematic use of cigarettes, alcohol and cannabis, there were both bivariate and multivariate statistically significant associations with greater psychopathology, lower mindfulness, and a lower quality of life. For example, greater psychopathology and stress experience were both associated with an increased risk of problematic cannabis use (odds ratios 1.21 [1.11; 1.31] and 1.59 [1.33; 1.88]). CONCLUSION: A comparison with the few available previous findings implies that problematic alcohol consumption has become more prevalent. There were both similarities and differences across the three substances studied with respect to patterns of problematic consumption, particularly in relation to the experience of stress.

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The ability to effectively cope with stress is impacted by early relationship experiences and, thus, is related to attachment security. We examined how different forms of attachment insecurity (namely, attachment anxiety and attachment avoidance) impact romantic partners' capacity for coping with stress individually (via self-regulation) and together (via dyadic coping) in a community sample of 261 heterosexual couples. We also explored links between these coping strategies and measures of well-being. Multiple regression analyses in this cross-sectional, self-report study indicated that attachment avoidance, but not anxiety, was linked to less effective dyadic coping. In men, this was also the case for partner's attachment avoidance. Attachment anxiety, but not avoidance, was related to self-regulation problems for women, while in men, both facets of attachment insecurity were negatively associated with self-regulation. Individual and dyadic coping strategies each uniquely contributed to individuals' well-being and satisfaction with life. Relationship interventions and counseling processes might benefit from sensitizing clients for biographical influences on their coping strategies.

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Adolescence is a critical phase for the development of substance use disorders (SUDs). For Europe and Germany, there are limited data on problematic substance use from representative youth samples. Trait mindfulness is relevant in buffering against substance use-related problems and associated deficits in self-regulatory control. The objective of this study is to estimate 12-month prevalence rates for SUDs in a representative sample of adolescents in Germany and to examine associations with mindfulness and related factors such as stress, impulsivity, sensation seeking and symptoms of psychopathology. A sample of 4001 adolescents aged 12-18 years from Germany was surveyed based on DSM-IV diagnostic criteria for SUDs. Logistic regression analyses were used to examine associations with mindfulness-related variables. Criteria of at least one of the assessed SUDs were endorsed by 11.2% of the adolescents. Alcohol use disorders had the highest prevalence rate (10.1%) followed by cannabis use disorders (2.6%). For both substances, the criteria for abuse were met about twice as often as those for dependence. The prevalence of cigarette dependence was 1.7%, while the prevalence for e-cigarette dependence was only 0.1%. Prevalence rates were higher for male youth and increasing with age. SUD prevalence was also related to mindfulness, impulsivity and sensation seeking and externalizing symptoms of psychopathology. The statistically significant associations varied across different SUDs. SUDs appear highly prevalent among German adolescents. The results have public health implications with regard to treatment needs and prevention measures in the youth population in Germany.

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While the use of video games and social media is an enjoyable recreational activity for most users, a minority develop problematic patterns of use. In the ICD-11, for the first time, there is a category of "disorders due to addictive behaviors" (including gaming disorder). The scientific literature also suggests a potential for the problematic use of social media. Economic screening tools for this are still needed. A very economical questionnaire to record gaming disorder is the ICD-11-based Gaming Disorder Test (GDT). The purpose of the present survey was to investigate the psychometric properties of an adapted questionnaire (Social Media Disorder Test, SMDT) to assess problematic social media use (PSMU). Therefore, 443 youths (mean age: 20.11 years) were examined with the SMDT and other measures regarding PSMU, self-control, and psychopathology. A confirmatory factor analysis (CFA) and reliability and correlation analyses were conducted. For the SMDT, we observed very good fit indices in the CFA, suggesting a one-factor structure; the reliability coefficient was 0.90, and we found the first indications for criterion validity. If the results can be confirmed, the SMDT, with its four questions, would be a very economical instrument to measure PSMU based on the ICD-11 criteria for behavioral addictions.

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BACKGROUND: Intense or problematic media use behavior of parents could serve as a role model for their children's media use behavior. So far, knowledge is scarce about increased children's media use (ICMU) and its association with parental stress (PS) and problematic parental media use (PPMU). METHODS: ICMU was examined using a modified set of the DSM-5 criteria for Internet Gaming Disorder. PS was assessed via the widely used Parenting Stress Index, and PPMU was assessed using the Short Compulsive Internet Use Scale. A multiple linear regression analysis was conducted to evaluate the links between ICMU, PS, and PPMU. A mediation analysis was performed to examine if PPMU mediated the relationship between PS and ICMU. RESULTS: In sum, 809 parents (M = 36.89 years; SD = 4.87; 81.4% female) of preschool children (average age: 44.75 months, SD = 13.68) participated in the study. ICMU was statistically significantly related to higher age of the parent, greater PPMU, and higher PS. Furthermore, we found that the association between PS and ICMU was partially mediated by PPMU. CONCLUSIONS: The results indicate that more pronounced PS and PPMU are associated with ICMU, highlighting the necessity of considering these parental variables when developing early prevention strategies for preschool-age children.

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Relatively common behavioral patterns in adolescence are problematic use of video games (PG), social media (PSMU) or alcohol (PAU). According to theoretical models, personality traits are relevant for Internet-related problematic behaviors. In the present study, associations of the Big Five personality domains and their 15 facets with PG, PSMU and PAU were compared for the first time. Therefore, 492 adolescents (mean age: 16.83 years) were examined with the established Big Five Inventory-2 as well as other standardized questionnaires on PG, PSMU and PAU. For statistical evaluation, correlation analyses were used as bivariate procedures and multiple regression analyses as multivariable procedures. At the personality domain level, consistently in bivariate and multivariate analyses, statistically significant associations between higher Negative Emotionality (Neuroticism) and PG, PSMU and PAU as well as between lower Open-Mindedness and PG and PAU were observed. At the level of facets, higher Anxiety (facet of Negative Emotionality) was related to PG and PSMU as well as lower Aesthetic Sensitivity (facet of Open-Mindedness) and lower Productiveness (facet of Conscientiousness) to PG. Considering the overlap of 95% confidence intervals, very comparable patterns of associations between PG, PSMU and PAU and the Big Five and their facets were observed in adolescence (indicating similarities in etiology).

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BACKGROUND: Use of Internet applications is often associated with postponing real-life obligations. Previous cross-sectional studies have reported a positive association between procrastination and Internet use disorders (IUDs). Further, procrastination is included in theoretical models explaining the development of IUDs. However, little is known about the temporal relationship; thus, longitudinal studies identifying the specific predictive direction are required. METHODS: Using a cross-lagged panel design, a total of 240 students who were at high risk for IUDs, aged between 12 and 18 years (M = 15.17, SD = 1.66) were assessed at baseline (t1) and reassessed one year later (t2) with standardized measures for IUDs and procrastination. RESULTS: Our results showed that IUD symptom severity at t2 was significantly predicted both by IUD symptom severity at t1 and procrastination at t1. However, procrastination at t2 was predicted only by procrastination at t1 but not by IUD symptom severity at t1. CONCLUSIONS: We could not find a reciprocal relationship between procrastination and IUD symptom severity. Procrastination appears to be a causal risk factor for IUDs, but not a consequence. As a modifiable risk factor, procrastination is a promising starting point for preventive and therapeutic interventions for IUDs.

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INTRODUCTION: According to current concepts of developmental tasks, both the use of digital media and the consumption of psychotropic substances are age-typical challenges for adolescents. The majority overcomes these developmental tasks, but a substantial proportion of youth develops problematic usage patterns (e.g., of video games) or problematic consumption behavior (e.g., of alcohol). Empirical findings show the importance of family aspects for these problematic behavior patterns. Currently, it is not clear which specific areas of parent-child relationship are associated in each case and whether there are differences between substance-related and substance-unrelated problematic behavioral patterns. METHODS: We surveyed 480 adolescents (45.2% females, mean age = 16.84 years) with standardized instruments regarding the mother-child relationship as well as problematic gaming, problematic social media use, and problematic alcohol use. We conducted correlation and multiple linear regression analyses (separately for problematic gaming, problematic social media use, and problematic alcohol use) as well as a multivariate multiple regression analysis. RESULTS: In the regression analyses, more conflicts with the mother were related to all three behavioral patterns. However, lower cohesion was only statistically significantly associated with problematic alcohol use, but not with problematic gaming and problematic social media use, whereas lower autonomy and more frequent punishment of the child were statistically significantly related to problematic gaming and problematic social media use, but not to problematic alcohol use. DISCUSSION/CONCLUSION: The findings indicate partially different relational dynamics for substance-related and substance-unrelated problem behaviors (interestingly, for cohesion and autonomy, the 95% confidence intervals of the standardized regression coefficients were not overlapping). The results of the present study could be used in family-based prevention approaches or in treatments in the clinical setting.

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Trajectories of internalizing disorders and behavioral addictions are still largely unknown. Research shows that both disorders are highly comorbid. Previous longitudinal studies have focused on associations between internalizing disorders and behavioral addictions using screening instruments. Our aim was to develop and examine a theory-based model of trajectories, according to which internalizing disorders foster symptoms of Internet use disorders, mediated by a reward deprivation and maladaptive emotion regulation. We applied clinically relevant measures for depression and social anxiety in a prospective longitudinal study with a 12-month follow-up investigation. On the basis of an at-risk population of 476 students (mean age = 14.99 years, SD = 1.99), we investigated the predictive influence of clinically relevant depression and social anxiety at baseline (t1) on Internet use disorder symptoms at 12-month follow-up (t2) using multiple linear regression analyses. Our results showed that both clinically relevant depression and social anxiety significantly predicted symptom severity of Internet use disorders one year later after controlling for baseline symptoms of Internet use disorders, gender and age. These results remained robust after including both depression and social anxiety simultaneously in the model, indicating an independent influence of both predictors on Internet use disorder symptoms. The present study enhances knowledge going beyond a mere association between internalizing disorders and Internet use disorders. To our knowledge, this is the first study investigating clinically relevant depression and social anxiety to predict future Internet use disorder symptoms at 12-month follow-up. In line with our model of trajectories, a significant temporal relationship between clinically relevant internalizing disorders and Internet use disorder symptoms at 12-month follow-up was confirmed. Further studies should investigate the mediating role of reward deprivation and maladaptive emotion regulation, as postulated in our model. One implication of these findings is that clinicians should pay particular attention to the increased risk of developing behavioral addictions for adolescents with depression and social anxiety.

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Internet Gaming Disorder (IGD) has been included in the DSM-5 as a diagnosis for further study, and Gaming Disorder as a new diagnosis in the ICD-11. Nonetheless, little is known about the clinical prevalence of IGD in children and adolescents. Additionally, it is unclear if patients with IGD are already identified in routine psychotherapy, using the ICD-10 diagnosis F 63.8 (recommended classification of IGD in ICD-10). This study investigated N = 358 children and adolescents (self and parental rating) of an outpatient psychotherapy centre in Germany using the Video Game Dependency Scale. According to self-report 4.0% of the 11- to 17-year-old patients met criteria for a tentative IGD diagnosis and 14.0% according to the parental report. Of the 5- to 10-year-old patients, 4.1% were diagnosed with tentative IGD according to parental report. Patients meeting IGD criteria were most frequently diagnosed with hyperkinetic disorders, followed by anxiety disorders, F 63.8, conduct disorders, mood disorders and obsessive-compulsive disorders (descending order) as primary clinical diagnoses. Consequently, this study indicates that a significant amount of the clinical population presents IGD. Meaning, appropriate diagnostics should be included in routine psychological diagnostics in order to avoid "hidden" cases of IGD in the future.

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Objective: The problematic use of computer games was included in the DSM-5 and in the ICD-11. Initial research revealed associations between problematic gaming (PG) and quality of life (QoL). However, clarification is needed concerning which dimensions of the multidimensional construct QoL are particularly relevant for PG. Method: To answer this question empirically, we asked 503 parents (mean age: 47.63 years) to rate their 503 children (average age: 14.60 years) regarding QoL and PG, using validated questionnaires on parental assessments of adolescent PG and health-related QoL to collect the data. Correlation analyses were calculated to determine bivariate relations, and a multiple linear regression was used to conduct a multivariable analysis. Results: In the bivariate analyses, a higher severity of PG was associated with a lower health-related QoL in all five surveyed dimensions. In the multivariable model (corrected R2 = 0.35), we observed statistically significant associations between higher severity of PG and male sex and lower age of the adolescent as well as lower QoL in the dimensions of physical well-being and school environment. Conclusions: According to the findings of the present study, physical well-being and school environment should be especially focused on in preventive approaches against the development of PG in youth.

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Alcohol consumption in adolescence is widespread. Several studies have investigated alcohol use in minors and its consequences in adulthood, but prospective findings on psychosocial predictors for problematic alcohol use (PAU) already in youth are still limited. Next to genetic aspects, psychosocial predictors appear to be particularly relevant. The objective of the present longitudinal survey was to explore psychosocial influences on PAU in adolescence. At baseline, 1,444 adolescents (52.1% girls, average age: 14.65 years) were surveyed. Two years later (at follow-up), we were able to re-assess 515 adolescents (mean age: 16.60 years). Both times, a standardized questionnaire was applied to explore PAU and various psychosocial aspects. We conducted multiple imputation, created 100 datasets with a Markov Chain Monte Carlo algorithm and calculated regression analyses to identify predictors for PAU. In a multivariable analysis, we found that female gender (protective factor), school-type 'Gymnasium' (highest level of school education, protective factor), PAU, more conduct problems and lower psychological well-being (all at baseline) predicted adolescent PAU at follow-up. In supplementary analyses for frequent alcohol use (regardless of quantity) and high alcohol consumption quantity (regardless of frequency), these predictors could only partially be found again. According to the findings of the present study, psychosocial aspects are relevant for PAU in adolescence, and particularly psychological well-being should be given more attention in primary prevention measures and treatment approaches.

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Problematic gaming (PG) has been included in the DSM-5 and ICD-11. But, it is still controversially discussed, if problematic (online-) gaming is a subtype of problematic Internet use (PIU) or if both behavior patterns should be distinguished. In joint samples, the relationships between PIU and PG and correlates have so far only been investigated in cross-sectional studies. This is the first longitudinal study to determine predictors of PIU, PG, and a combined occurrence of PIU and PG (PIU + PG) together in one sample. Overall, 985 family dyads (one parent and her/his child) were interviewed twice (at t1 and t2, with one year in between) with a standardized questionnaire regarding PIU, PG and psychosocial aspects. Predictors for adolescent PIU, PG, and PIU + PG were determined with a multinomial logistic regression analysis. The following were our findings: (a) PIU (t2) was predicted by stronger emotional distress (t1) and PIU (t1); (b) PG (t2) by male gender, more self-esteem problems (t1), stronger hyperactivity/inattention (t1), and PG (t1); and (c) PIU + PG (t2) by male gender, stronger hyperactivity/inattention (t1), and PG (t1). Partly different patterns of predictors were observed for the development of PIU and PG. The results indicate not only commonalities but also differences in the etiology of these behavior patterns.

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Adolescents frequently show risky behavior, and these problematic behavior patterns often do not occur in isolation, but together. Problematic alcohol use is widespread among youth, as is problematic use of the Internet and of specific online applications (video games or social media). However, there is still a lack of findings for minors regarding the relations between these behavioral patterns (particularly between problematic alcohol use and problematic gaming or problematic social media use). Standardized instruments were used to survey problematic alcohol use, problematic gaming, problematic social media use, problematic Internet use and mental health among 633 adolescents (mean age: 15.79 years). Bivariate correlation and multivariable linear regression analyses were conducted. The correlation analyses showed statistically significant positive bivariate relationships between all four behavioral patterns each. Antisocial behavior was related to all problematic behavioral patterns. Whereas, emotional distress, self-esteem problems and hyperactivity/inattention were associated with substance-unrelated problematic behavior patterns only. Anger control problems were related to problematic alcohol use and problematic gaming. In adolescence, the findings revealed small effect sizes between substance-related and substance-unrelated problematic behavior patterns, but moderate to large effect sizes within substance-unrelated behavioral patterns. Similarities and differences were found in the relations between the behavioral patterns and mental health.

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Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy Abstract. Media-associated disorders (MAD) describe the problematic use of the internet, certain electronic devices in general as well as digital applications. During childhood and adolescence, digital games and social media are the most commonly used applications. In May 2019, as first MAD "gaming disorder" was included as a clinical diagnosis in the ICD-11. The prevalence of MAD in German children and adolescents is estimated to lie between 3 % and 5 %. In most cases, MAD are accompanied by psychiatric comorbidities. MAD ensue because of dysfunctional learning processes in combination with general and specific risk factors. They are associated with neural changes like those of substance-associated addictions. Diagnostics can be based on validated questionnaires and clinical exploration, though a standardized diagnostic path is not yet common. Treatment depends on the level of severity and generally comprises outpatient, day-clinic, and inpatient therapy approaches with elements from cognitive-behavioral therapy and under parental involvement. Suitable treatments are not yet available in all German regions and have also not been sufficiently evaluated. Moreover, only a few studies exist on the efficacy of prevention measures addressing MAD in children and adolescents. Thus, further research is strongly required.

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Problematic use of the Internet is becoming increasingly important and especially for adolescents, high prevalence rates are reported in many countries. Despite the growing international research activities and the reported prevalence estimates, comparatively very few studies have focused on spontaneous remission and its possible causes. In a risk population of 272 adolescents, we used standardized diagnostic instruments to investigate which socio-demographic and psychosocial characteristics at baseline (at t1) predicted spontaneous remission of problematic Internet use one year later (at t2). The predictors were determined by bivariate and multivariate logistic regression analyses. In the bivariate regressions, we found male gender, higher self-efficacy (t1), a lower level of maladaptive emotion regulation strategies (t1), lower depression (t1), lower performance and school anxiety (t1), lower social-interaction anxiety (t1), and lower procrastination (t1) to predict spontaneous remission of problematic Internet use at t2. In the multivariable analysis, a lower level of maladaptive emotion regulation strategies (t1) was the sole statistically significant predictor for the remission one year later (t2). For the first time, the high relevance of emotion regulation for spontaneous remission of adolescent problematic Internet use was observed. Based on these findings, emotion regulation could be specifically trained and promoted in future prevention measures.

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In 2013, Internet gaming disorder (IGD) was incorporated in the DSM-5. In 2018, the World Health Organization (WHO) confirmed the inclusion of the new diagnosis "Gaming disorder" in the ICD-11. Both IGD and Gaming disorder refer to a problematic use of video games. Yet, IGD has thus far only been assessed by self-ratings, while external ratings have not been available. We adapted a frequently used screening tool for IGD (Internet Gaming Disorder Scale, IGDS) to a parental rating (Parental version of the Internet Gaming Disorder Scale, PIGDS) and evaluated its psychometric properties. Data were collected in 1,970 face-to-face interviews (with 985 parents and 985 related adolescents) using a standardized questionnaire measuring adolescent IGD by self- and parental ratings and frequency of gaming, psychopathological burden, hyperactivity/inattention, family functioning, and school performance. Furthermore, we determined the accordance of adolescent and parental ratings for IGD. We conducted a confirmatory factor analysis, correlation analyses, and have determined reliability and concordance. We observed a one-dimensional factor structure of the PIGDS and its internal consistency was 0.86. We found very first indications of criterion validity for the PIGDS. The correlation between IGDS and PIGDS was 0.78 and we observed kappa coefficients between both ratings of 0.62 and 0.61 (based on the most suitable cutoff points for the PIGDS). Both adolescent and parental ratings of IGD were consistently associated with higher psychopathological burden, stronger hyperactivity/inattention, poorer family functioning, and poorer school performance. According to the results, a parental assessment of IGD in adolescence seems to be a promising new approach and it opens a new perspective in the exploration of IGD.

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BACKGROUND: Early and excessive alcohol use is a significant threat to healthy development. Evidence supports the effectiveness of electronic alcohol interventions for young drinkers. However, effects are typically small and studies targeting under 18-year-olds are scarce. This trial is the first to evaluate the effectiveness of a single-session, brief, motivational, web-based intervention (ProWISE) plus weekly text-message-initiated individualised prompts (TIPs) in reducing alcohol consumption and alcohol-related harm among children and adolescents aged ≥ 12 years. TIPs are designed to decrease risky alcohol use by reaching youth in the contexts of their everyday lives and by providing individualised feedback on drinking intentions, actual drinking and succession in achieving personal goals for low-risk drinking or abstinence. METHODS/DESIGN: The trial is part of the multicentre consortium ProHEAD testing e-interventions for mental health problems in children and adolescents. Participants in grades 6-13 aged ≥ 12 years will be recruited in schools which participate in ProHEAD (target N = 15,000). Main criterion for inclusion in the ProWISE-TIP trial is a positive screening for at-risk alcohol use in the CRAFFT-d questionnaire (target n = 1076). In a multicentre, four-arm, randomised controlled design the following groups will be compared: (A) web-based intervention plus TIPs for 12 weeks; (B) web-based intervention plus text-message-initiated assessment of alcohol consumption for 12 weeks; (C) web-based intervention only; and (D) alcohol-related psychoeducation. TIPs will be delivered shortly before and after high-risk situations for excessive alcohol use and will be tailored to age, gender, drinking motives and alcohol consumption. Study participants will be followed up at three, six and nine months in the ProWISE-TIP trial and at one and two years in the ProHEAD consortium. Primary outcome is alcohol use in the past 30 days at nine months after enrolment. Secondary outcomes are alcohol-related problems, co-occurring substance use, health service utilisation, mental health problems and quality of life. DISCUSSION: Trial results will generate important evidence on how to enhance effectiveness of single-session, web-based alcohol interventions for youth. The ProWISE-TIP intervention, if effective, can be used as a stand-alone alcohol intervention or as an add-on to school-based or community-based alcohol prevention programs. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00014606 Registered on 20 April 2018.

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BACKGROUND: In 2013, Internet gaming disorder (IGD) was incorporated in the current version of the DSM-5. IGD refers to a problematic use of video games. Longitudinal studies on the etiology of IGD are lacking. Furthermore, it is currently unclear to which extent associated psychopathological problems are causes or consequences of IGD. In the present survey, longitudinal associations between IGD and adolescent and parental mental health were investigated for the first time, as well as the temporal stability of IGD. METHODS: In a cross-lagged panel design study, family dyads (adolescent with a parent each) were examined in 2016 (t1) and again 1 year later (2017, t2). Overall, 1095 family dyads were assessed at t1 and 985 dyads were re-assessed at t2 with standardized measures of IGD and several aspects of adolescent and parental mental health. Data were analyzed with structural equation modeling (SEM). RESULTS: Male gender, a higher level of hyperactivity/inattention, self-esteem problems and IGD at t1 were predictors of IGD at t2. IGD at t1 was a predictor for adolescent emotional distress at t2. Overall, 357 out of the 985 adolescents received a diagnosis of IGD at t1 or t2: 142 (14.4%) at t1 and t2, 100 (10.2%) only at t1, and 115 (11.7%) only at t2. CONCLUSIONS: Hyperactivity/inattention and self-esteem problems seem to be important for the development of IGD. We found first empirical evidence that IGD could prospectively contribute to a deterioration of adolescent mental health. Only a subgroup of affected adolescents showed IGD consistently over 1 year.

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BACKGROUND: In this study, we determined the current prevalence of depressive symptoms in adolescents in Germany. METHODS: A sample of 1001 adolescents aged 12 to 17 that was representative for Germany was surveyed in August and September 2017 through telephone interviews about depressive symptoms in the two weeks leading up to the interview and about the subjects' psychosocial features. The instrument that was used, called DesTeen, includes questions about depressed mood, loss of interest, loss of energy, feelings of worthlessness, guilt feelings, and cognitive symptoms. RESULTS: Prevalences could be estimated and associated factors could be determined in a subset comprising 988 of the original 1001 subjects (mean age 14.58 years, 48.4% female). The estimated point prevalence of depressive symptoms (summated DesTeen score ≥ 14) in adolescents aged 12 to 17 was 8.2% (95% confidence interval [6.5; 9.9]). Girls (11.6% [95% CI 8.8; 14.4]) were more commonly affected than boys (5.0% [95% CI 3.1; 6.9]), and this difference was statistically significant (p<0.001). Depressive symptoms were more common with female sex, older age, poorer scholastic performance, lower interpersonal trust, more negative body image, more problematic use of social media or computer games, and lower family functioning. A multivariable regression model explained approximately one-third of the variation among groups (Nagelkerke's R2 = 0.35). CONCLUSION: A substantial percentage of German adolescents suffers from depres - sive symptoms. This study was the first to show certain associations, such as that between depressive symptoms in adolescence and the problematic use of social media in German youth.

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