Girls from poor families are less likely to be diagnosed with depression

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Depression, anxiety, eating disorders (symbolic image): "Adolescent girls visibly bear the greatest burden"

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The good news comes with heavy baggage: The number of mental illnesses among young people between the ages of 15 and 17 fell last year, as the DAK Children and Youth Report shows. In 2022, eleven percent fewer adolescent girls received a new diagnosis in this area than in 2021, and there was a decrease of five percent among boys. However, compared to the pre-Corona year of 2019, significantly more young people – especially girls – are affected.

According to the data, the number of mental illnesses among adolescent girls increased by six percent between 2019 and 2022: in total, around 2022,110 of them were newly diagnosed with a mental illness or behavioral disorder in 000. Girls between the ages of 15 and 17 suffer the most from depression, anxiety disorders and eating disorders. Experts speak of internalizing diseases in which those affected withdraw into themselves.

»We are in a mental health pandemic«

"There can be no talk of a normalization of the situation. There is no all-clear," the DAK quotes Christoph Correll, Director of the Clinic for Psychiatry, Psychosomatics and Psychotherapy of Childhood and Adolescence at Berlin's Charité. The rates of new cases of mental illness stabilized at a high level. "We are still in a mental health pandemic. And teenage girls visibly bear the greatest burden."

A look at the DAK figures shows where the problems lie in detail: The rate of new cases among girls with depression, for example, fell by eleven percent in 2022 compared to 2021 (in 2021, statistically speaking, 46.4 out of 1000 girls received this diagnosis, in 2022 it was 41.4 out of 1000). Compared to 2019, however, there is an increase of 24 percent (33.3 girls out of 1000).

While anxiety disorders decreased by three percent compared to 2021, the number increased by 2019 percent compared to 44, while eating disorders saw a decrease of 14 percent last year but an increase of 2019 percent compared to 51.

Unlike girls, boys between the ages of 15 and 17 are less likely to receive treatment for mental illness or behavioral disorders, according to the analysis. In 2022, for example, eight percent fewer male 15- to 17-year-olds received a new diagnosis in this area than in the pre-pandemic year of 2019. Boys react to psychological stress situations with so-called externalizing behavior, says Thomas Fischbach, President of the Professional Association of Pediatricians and Adolescent Physicians, according to the DAK. This is, for example, aggressive, impulsive or oppositional behavior. It is undisputed that this has been further intensified by the pandemic situation. "Externalizing disorders are often not considered mental disorders, but rather social behavior disorders," says Fischbach. "So they're probably underdiagnosed."

Differences between rich and poor

The report also reveals what experts are now more likely to describe: whether a teenager is diagnosed with mental illness is also related to the social status of his family. According to DAK figures, the number of 15- to 17-year-old girls diagnosed with depression from poor and socially disadvantaged families was about the same in 2022 (36 out of 1000 girls in the age group) as in 2019 (35.9 out of 1000). For girls from families with high socioeconomic status, on the other hand, the numbers increased by 2019 percent between 34 (2.1000 out of 2022) and 28 (43.6 out of 1000).

According to Correll, a child and adolescent psychiatrist at the Charité hospital in Berlin, however, this does not lead to the conclusion that adolescents from socially disadvantaged backgrounds are generally less mentally ill: "They are only less likely to seek treatment. It seems to me that there is a large number of unreported cases among the lower social classes." There is concern that children and adolescents from socially disadvantaged families do not have the same opportunities for treatment as their peers from other social classes. The central question is therefore how to ensure that social status does not play a role in care in Germany. "We need to strengthen school social work and open child and youth work," says Correll. "We need to educate people and break down stigmas."

At the same time, it becomes clear how children from better-off families benefit significantly from the support of their social environment. In addition, the hurdles to seeking medical and psychological help seem to fall here. "I suspect that parents and custodians are more likely to look in socially better-off families than in families with low social status," Correll said. "Medical help is sought earlier." Fischbach, a paediatrician and adolescent, says that people with a high level of education perceive the stresses and strains in their often intact environment in a more differentiated and particularly threatening way. "Especially with a high level of individual sensitivity, they react with anxiety and depression," says Fischbach. "That's how I see it in my own practice."

Scarce therapy place

The problem with the detection and treatment of mental illness is that therapy places are scarce in this country. A survey by the German Psychotherapists' Association (DPtV) in 2021 showed that almost 40 percent of children and adolescents had to wait longer than half a year for a psychotherapeutic treatment place.

In 2018, psychotherapeutic consultation hours were introduced, also due to the shortage of therapy places in Germany. In order to bridge waiting times and support the patient in finding the right help or form of therapy, people with statutory health insurance should initially seek advice in up to three consultation hours – also known as probationary sessions – of 50 minutes each. Children, adolescents and young adults up to the age of 21 can take advantage of five such sessions. However, according to the DPtV survey, 43.4 percent of children and adolescents who wanted to attend such an initial consultation also had to wait longer than a month.

Since 2020, the non-profit company »Krisenchat« has been offering a free 24/7 hotline for children and young people with mental health problems – regardless of parental support. In schools, the model project "Mental Health Coaches" was also launched in schools in September. They are intended to provide initial psychological help in acute crises and refer people to further support services, but also to act as a preventive contact person. Ulrike Ravens-Sieberer, a health researcher at the University Medical Center Hamburg-Eppendorf, told SPIEGEL about the project: "We need a low-threshold service that is accessible to all children and adolescents and is also financed. This would be an important step for the prevention of mental illness."