Risk and protective factors for children's and adolescents' mental health: results of the BELLA study

Background Since prevalence rates of mental health problems in children and adolescents are high and of considerable relevance to public health, determinants of mental health, such as risk and protective factors, are of special interest. Objectives The present paper reports the frequencies and distributions of potential risk and protective factors and analyses their effects on children's mental health. Methods The BELLA study is the mental health module of the German National Health Interview and Examination Survey among Children and Adolescents (KiGGS). Mental health problems and their assumed determinants are examined in a representative sub-sample of 2,863 families with children and adolescents aged 7-17. In order to identify mental health problems, the extended version of the Strengths and Difficulties Questionnaire was administered. Data on psychosocial risk factors as well as on protective factors in terms of personal, familial and social resources were collected by questioning the parents and, from the age of 11 years upwards, the children themselves. Results Adverse family climate stands out particularly as a negative contributor to children's mental health. When several risk factors occur simultaneously, the prevalence of mental health problems increases markedly. Conversely, pronounced individual, family and social resources coincide with a reduced occurrence of mental health problems, especially in children with a limited number of risk factors. Conclusions The results suggest that differential prevention strategies are needed depending on the risk level: in the low risk group, to which most children belong, effective prevention programmes should define strengthening resources as a key objective. In the smaller group of children with a high number of risk factors, more complex intervention designs are required, which must consider the reduction of risks as well as strengthening resources.