European Child & Adolescent Psychiatry

, Volume 24, Issue 6, pp 651–663 | Cite as

The longitudinal BELLA study: design, methods and first results on the course of mental health problems

  • Ulrike Ravens-SiebererEmail author
  • Christiane Otto
  • Levente Kriston
  • Aribert Rothenberger
  • Manfred Döpfner
  • Beate Herpertz-Dahlmann
  • Claus Barkmann
  • Gerhard Schön
  • Heike Hölling
  • Michael Schulte-Markwort
  • Fionna Klasen
  • The BELLA study group
Original Contribution


The high prevalence of mental health problems (MHP) in childhood and adolescence is a global health challenge of the 21st century. Information about age of onset, persistence and development of MHP in young people is necessary to implement effective prevention and intervention strategies. We describe the design and methods of the longitudinal BELLA study, which investigates developmental trajectories of MHP from childhood into adulthood, their determinants, and the utilisation of mental health services. First results on the developmental course of MHP in children and adolescents are reported over a 6-year period. The BELLA study is the mental health module of the German National Health Interview and Examination Survey for children and adolescents (KiGGS). BELLA examines the mental health and well-being of children and adolescents aged 7–17 years (a representative subsample of KiGGS, n = 2,863 at baseline). Standardised screening measures served to identify MHP at baseline and at follow-ups (1, 2, and 6 years later). Among children and adolescents participating at all measurement points (n = 1,255), 10 % showed clinically significant MHP at baseline (n = 130). Over the 6-year period, 74.3 % showed no signs of MHP (n = 933), 15.5 % had remitted (n = 194), 2.9 % showed persistent (n = 36) and 7.3 % acute or recurrent MHP (n = 92). Overall, MHP were more likely to occur between the age of 7 and 12 and after the age of 19 years. Regarding mental health service use, 33 % of the participants with acute or recurrent MHP (n = 30) and 63.9 % with persistent MHP used mental health services (n = 23). Mental health problems in children and adolescents have a high risk to persist into adulthood. In children and adolescents a low rate of mental health service use was observed, even among those with mental health problems.


Mental health Children and adolescents Longitudinal study BELLA study Cohort Germany 



The authors thank all children, adolescents, their parents and young adults who participated in this research for their time and involvement. We are very grateful to all the researchers and students who worked on this project and made it possible, especially to: Dr. Nora Wille, Dr. Birte Hintzpeter, Franziska Reiss, Anne-Catherine Haller, Helen Bichmann, Catharina Voss, Julia Pranicka, Ann‐Katrin Meyrose and Praveetha Patalay; we are also grateful to all the researchers working with us on this ECAP special issue, especially to: PD Dr. Astrid Dempfle, Dr. Anja Görtz‐Dorten, PD Dr. Christopher Hautmann and Dr. Andreas Becker. We would like to thank the Robert Koch Institute for their ongoing support and co-operation. The BELLA study has been financially supported by various grants: Baseline, 1-year follow-up and 2-year follow-up of the BELLA study were financed by the German Science Foundation. The 6-year follow-up was funded by the German Federal Ministry of Health (BMG).

Conflict of interest

None of the authors has a conflict of interest to disclose.

Supplementary material

787_2014_638_MOESM1_ESM.docx (105 kb)
Supplementary material 1 (DOCX 105 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Ulrike Ravens-Sieberer
    • 1
    Email author
  • Christiane Otto
    • 1
  • Levente Kriston
    • 1
    • 2
  • Aribert Rothenberger
    • 3
  • Manfred Döpfner
    • 4
  • Beate Herpertz-Dahlmann
    • 5
  • Claus Barkmann
    • 1
  • Gerhard Schön
    • 6
  • Heike Hölling
    • 7
  • Michael Schulte-Markwort
    • 1
  • Fionna Klasen
    • 1
  • The BELLA study group
  1. 1.Department of Child and Adolescent Psychiatry, Psychotherapy, and PsychosomaticsUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Department of Medical PsychologyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  3. 3.Department of Child and Adolescent Psychiatry and PsychotherapyUniversity Medical Center GöttingenGöttingenGermany
  4. 4.Department of Psychiatry, Psychosomatics and Psychotherapy in Childhood and Adolescence, Medical FacultyUniversity of CologneCologneGermany
  5. 5.Department of Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyUniversity Clinics, RWTH AachenAachenGermany
  6. 6.Department of Medical Biometry and EpidemiologyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  7. 7.Robert Koch InstituteBerlinGermany

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