Pedagogiek - Volume 39, Issue 2, 2019

Self-harming behavior: complex, but recovery is possible

Self-harming behavior among adolescents is an alarming phenomenon: it is a sign of underlying suffering and not knowing how to handle this. Often, there are intense and overwhelming emotions which are unbearable for these patients, or emotions can be completely absent. There are indications that the number of adolescents who self-harm is increasing. In contact with these young people the attitude of professionals is extremely important. Self-harming behavior also has a great impact on professionals, in some cases leading to a deterioration of the relationship with the patient who self-harms. In the first part of this article the phenomenon of self-harm will be described, as well as the prevalence of self-harm among adolescents. In the second part, a qualitative study regarding the patients’ perspective on recovery from severe self-harming behavior is presented. Semi-structured interviews were conducted with 12 women who had successfully stopped their severe self-harming behavior. Although the participants were adults, their problems started during adolescence, thereby influencing their recovery. The study was executed based on the grounded theory method. The researchers found that the process of stopping self-harm proceeds according to six phases. The bond between professional and patient was identified as key to all phases of the process of recovery. Interventions should focus on strengthening the therapeutic relationship between professional and patient, encouraging patients to develop a more positive self-image and stimulate them to learn alternative behavior for self-harm.

Suicide and attempted suicide by young people in Amsterdam. What do we know about the background and factors associated with suicide and suicidal behaviors?

At the end of 2016, suicide among adolescents has been on the rise among Dutch youth. This finding highlights the importance of collecting relevant information concerning adolescent suicide. In this study, we will take a first step in collecting knowledge prior to this rise regarding the background, characteristics and precipitating factors of suicidality in Dutch youth in Amsterdam in the period between 1996 and 2010. Two types of files were collected; for suicides in Amsterdam, coroners’ files were collected (1996-2010). For suicide attempts, we collected medical files from the emergency room of a hospital in Amsterdam (2003-2006). Regarding suicides of young people, we mainly see young men between the ages of 18-23 who mainly died through hanging, jumping from height or in front of a train. Few other factors were recorded in the coroners’ files. Regarding suicide attempts, five themes were visible: 1) demographic and social factors; older adolescents and girls were strongly overrepresented, and a third of all attempters had a non-Dutch origin; 2) Stressful life events, particularly sexual abuse and parental divorce; 3) psychological issues and psychiatric disorders, especially depression and borderline personality; 4) trigger factors consisting of conflicts and disputes with parents or a partner and lastly, 5) previous self-harm or attempts were frequently noted. This study provides a very first indication of relevant factors that could assist in future research about the recent rise in Dutch adolescent suicide and guide prevention efforts. To generate more specific epidemiological knowledge, and in order to formulate prevention strategies more optimal data-gathering systems are needed that systematically take a wide range of known risk factors into account.

Same-sex sexual attraction and gender non-conformity: The influence of parent acceptance

The current study assessed, separately for boys and girls, the moderating effects of mother/father acceptance in the relationship of same-sex attraction (SSA) and gender nonconformity with psychological distress and social anxiety. Data were collected from 1,121 secondary school students (539 boys and 582 girls; Mage = 16.6) by means of a paper–pencil questionnaire. Multiple regression analyses showed that for boys, father acceptance moderated the associations of gender nonconformity with psychological distress (including depressive symptoms) and social anxiety. For boys with high levels of father acceptance, GNC was not significantly associated with psychological distress and social anxiety, when compared with boys with low and mean levels of father acceptance. Mother acceptance did moderate the association between SSA and social anxiety for girls. For girls with mean and high levels of mother acceptance, SSA was not associated with social anxiety, when compared with girls who reported low levels of acceptance by their mothers.

Parent-adolescent conflicts and depressed mood among Surinamese-Hindustani female adolescents in the Netherlands: an online daily diary study

Suicidal behavior is two to four times more common in Surinamese-Hindustani than in Dutch young women in the Netherlands. The decreased well-being of these adolescents is often related to a poor relationship with their parents. To date, quantitative studies in which the relation between an increased risk of depression, an important risk factor for suicide, and the parent-adolescent relationship in this ethnic-cultural group is investigated are lacking. In an attempt to understand this relation better, we conducted an online daily diary study on differences between Surinamese-Hindustani and Dutch adolescents (age 16-26) with regard to depressed mood, frequency of parent-adolescent conflicts, topics of conflict, and the strength of the relationship between the number of parent-adolescent conflicts and depressed mood. The adolescents completed questionnaires, including the Beck Depression Inventory (BDI), followed by a 14-day online daily diary tracking the frequency and topics of parent-adolescent conflicts, as well as general affect. Analyses revealed that (1) there were no differences between Surinamese-Hindustani and Dutch participants regarding depressed mood and frequency of parent-adolescent conflicts (2) Surinamese-Hindustani participants experienced more conflicts with their parents about autonomy than Dutch participants (3) the frequency of parent-adolescent conflicts was related to depressed mood among Dutch, but not among Surinamese-Hindustani participants.

Cognitive behavioural therapy and depressive symptoms among youth with and without Mild Intellectual Disability in residential care: an exploratory study investigating ‘Op Volle Kracht’

Depression is at least as prevalent in youth with a mild intellectual disability (MID) as it is in youth without disabilities. Little is known however about the etiology and treatment of depression in this group. This paper aims to investigate the possiblities for cognitive behavioural therapy in youth with MID by (1) testing the validity of Beck’s cognitive theory and Nolen-Hoeksema’s response style theory in youth with and without a MID in residential youth care; and (2) to examine the effects of Op Volle Kracht (OVK), a CBT-based depression prevention program among youth with and without a MID in a residential treatment setting. In study 1 the relationship between negative cognitive errors (Beck), response styles (Nolen- Hoeksema) and depressive symptoms was examined in 135 adolescents (age 9-17 years) using linear regression. Study 2 was an initial cluster randomized controlled trial in which twenty residential treatment groups (including in total N=92 adolescents aged 9-17 years), half of which targeted adolescents with a MID, were randomly assigned to either treatment as usual (TAU), or a combination of TAU and the group-CBT-program Op Volle Kracht (OVK+TAU). Depressive symptoms, cognitive errors and response styles were assessed at pre-test, post-test and 3 months follow-up. The data were analyzed by mixed effects linear regression analyses with age and gender as covariates.

Results Study 1 showed that only the cognitive error ‘underestimation of the ability to cope’, and a ruminative and distractive response style predicted depressive symptoms in both youth with- and without MID. The negative cognitive error ‘underestimation of the ability to cope’ was more prevalent among youth with MID than among youth without MID. Study 2 showed that the group CBT-program OVK was effective in reducing rumination, but not in reducing depressive symptoms or cognitive errors. This effect was the same for youth with and without a MID. The main premises of Beck’s cognitive theory and Nolen-Hoeksema’s response style theory of depression are applicable to both youth with and without a MID. The cognitive error ‘underestimation of the ability to cope’ poses a specific risk factor for developing a depression for youth with a MID and may require special attention in treatment and prevention of depression. The specifically adapted program OVK did not show effectiveness in reducing symptoms of depression in youth in residential care.

Outcomes of a randomized controlled trial on the effectiveness of depression and anxiety prevention for adolescents with a high familial risk

A randomized controlled trail was conducted to examine the effectiveness of a depression and anxiety prevention program ‘Een Sprong Vooruit’ (A Leap Forward) among adolescent girls (N = 142) with a high familial risk. The results showed neither effects of the prevention program directly after the intervention, nor at 6 or 12 months follow-up on depression and anxiety symptoms. Further, latent growth curve modeling (LGCM) was used to examine whether the growth functions for the intervention and the control condition were different. The slope representing the change in depression symptoms was not significantly different between the intervention and the control condition. For anxiety symptoms, the difference between slopes was also not significant. Based on findings, we suggested that these high-risk adolescent girls might benefit more from a more intensive prevention program.