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


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.

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  1. 1.

    Other analyses of the BELLA data within this ECAP special issue used various procedures to deal with missing data, so that robustness of the findings can easily be assessed.

  2. 2.

    Both of these aspects are covered in two additional papers in this ECAP special issue offering corresponding analyses based on BELLA data.


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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.

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Correspondence to Ulrike Ravens-Sieberer.

Additional information

Members of the BELLA study group are: Ulrike Ravens-Sieberer and Fionna Klasen, Hamburg (Principal Investigators); Claus Barkmann, Hamburg; Monika Bullinger, Hamburg; Manfred Döpfner, Köln; Beate Herpertz-Dahlmann, Aachen; Heike Hölling, Berlin; Franz Resch, Heidelberg; Aribert Rothenberger, Göttingen; Sylvia Schneider, Bochum; Michael Schulte-Markwort, Hamburg; Robert Schlack, Berlin; Frank Verhulst, Rotterdam; Hans-Ulrich Wittchen, Dresden.

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Ravens-Sieberer, U., Otto, C., Kriston, L. et al. The longitudinal BELLA study: design, methods and first results on the course of mental health problems. Eur Child Adolesc Psychiatry 24, 651–663 (2015).

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  • Mental health
  • Children and adolescents
  • Longitudinal study
  • BELLA study
  • Cohort
  • Germany