Gloria Fischer

Pathological Internet use among European adolescents: psychopathology and self-destructive behaviours

Rising global rates of pathological Internet use (PIU) and related psychological impairments have gained considerable attention in recent years. In an effort to acquire evidence-based knowledge of this relationship, the main objective of this study was to investigate the association between PIU, psychopathology and self-destructive behaviours among school-based adolescents in eleven European countries. This cross-sectional study was implemented within the framework of the European Union project: Saving and Empowering Young Lives in Europe. A representative sample of 11,356 school-based adolescents (M/F: 4,856/6,500; mean age: 14.9) was included in the analyses. PIU was assessed using the Young’s Diagnostic Questionnaire. Psychopathology was measured using the Beck Depression Inventory-II, Zung Self-Rating Anxiety Scale and Strengths and Difficulties Questionnaire. Self-destructive behaviours were evaluated by the Deliberate Self-Harm Inventory and Paykel Suicide Scale. Results showed that suicidal behaviours (suicidal ideation and suicide attempts), depression, anxiety, conduct problems and hyperactivity/inattention were significant and independent predictors of PIU. The correlation between PIU, conduct problems and hyperactivity/inattention was stronger among females, while the link between PIU and symptoms of depression, anxiety and peer relationship problems was stronger among males. The association between PIU, psychopathology and self-destructive behaviours was stronger in countries with a higher prevalence of PIU and suicide rates. These findings ascertain that psychopathology and suicidal behaviours are strongly related to PIU. This association is significantly influenced by gender and country suggesting socio-cultural influences. At the clinical and public health levels, targeting PIU among adolescents in the early stages could potentially lead to improvements of psychological well-being and a reduction of suicidal behaviours.

Suicide prevention for youth - a mental health awareness program: lessons learned from the Saving and Empowering Young Lives in Europe (SEYLE) intervention study

BackgroundThe Awareness program was designed as a part of the EU-funded Saving and Empowering Young Lives in Europe (SEYLE) intervention study to promote mental health of adolescents in 11 European countries by helping them to develop problem-solving skills and encouraging them to self-recognize the need for help as well as how to help peers in need.MethodsFor this descriptive study all coordinators of the SEYLE Awareness program answered an open-ended evaluation questionnaire at the end of the project implementation. Their answers were synthesized and analyzed and are presented here.ResultsThe results show that the program cultivated peer understanding and support. Adolescents not only learned about mental health by participating in the Awareness program, but the majority of them also greatly enjoyed the experience.ConclusionsRecommendations for enhancing the successes of mental health awareness programs are presented. Help and cooperation from schools, teachers, local politicians and other stakeholders will lead to more efficacious future programs.

The German version of the self-injurious thoughts and behaviors interview (SITBI-G): a tool to assess non-suicidal self-injury and suicidal behavior disorder

BackgroundSelf-injurious thoughts and behaviors (SITBs) are common in adolescents. While there is no standardized interview in German to assess SITBs to date, the Self-Injurious Thoughts and Behaviors Interview (SITBI) is widely used in English-speaking countries. However, the SITBI has not been validated for the assessment of the recently issued DSM-5 Section 3 diagnoses of nonsuicidal self-injury (NSSI) and suicidal behavior disorder (SBD) yet. In the present study the psychometric properties of the German version of the SITBI (SITBI-G) were assessed. We also evaluated whether SITBI-G is a reliable and valid instrument to establish diagnoses of NSSI and SBD.MethodsA clinical adolescent sample (N = 111, f/m = 73/38, age range = 12-19 years) was recruited from the inpatient units of three departments of child and adolescent psychiatry in Germany. All participating patients were interviewed by using the SITBI-G, and DSM-5 criteria of NSSI and SBD were operationalized from the SITBI-G data. Additionally, participants were given the Self-Harm Behavior Questionnaire (SHBQ), and SITBI-G was retested in a subsample.ResultsThe SITBI-G shows moderate to good test-retest reliability, a very good interrater reliability, and a good construct validity. The results demonstrate that diagnoses of NSSI and SBD can be established using the SITBI-G, achieving moderate to good test-retest reliabilities and very good to perfect interrater reliabilities.ConclusionsOverall, the good psychometric properties of SITBI-G are comparable to the original version of the interview. Therefore, SITBI-G seems to be highly appropriate to assess SITBs, including the new DSM-5 Section 3 diagnoses NSSI and SBD in research and clinical contexts.

The association of non-suicidal self-injury and suicidal behavior according to DSM-5 in adolescent psychiatric inpatients

Non-suicidal self-injury (NSSI) and suicidal behaviors frequently occur among adolescent psychiatric patients. Although those behaviors are distinct with regards to intent, NSSI has been shown to be an important risk-factor for suicide attempts. However, the association of NSSI and Suicidal Behavior Disorder (SBD) according to DSM-5 criteria has not yet been investigated. For investigating distinctive features and mutual risk-factors of NSSI-disorder and SBD, adolescent psychiatric inpatients (N=111, aged 12-19 years; 65.8% females) were interviewed using the Self-Injurious-Thoughts-And-Behaviors-Interview-German (SITBI-G). NSSI started significantly earlier in life (M=12.5 years, SD=2.2) than first suicide attempts (M=14.1 years, SD=2.0). Patients meeting NSSI-disorder and/or SBD were significantly more likely to be female and to be diagnosed with an affective disorder. NSSI-disorder and SBD seem to have several distinctive features (i.e. age of onset or frequency), but also seem to share certain mutual risk-factors (i.e. affective disorders, female gender). While both NSSI and SBD seem to be maintained by mainly automatic negative reinforcement, positive automatic and social functions were rated significantly higher for NSSI. Most importantly, NSSI seems to be a strong risk factor for the occurrence of SBD (even when controlling for suicidal ideation) and should therefore always be assessed when dealing with psychiatric adolescent patients.

The Specific Role of Childhood Abuse, Parental Bonding, and Family Functioning in Female Adolescents With Borderline Personality Disorder

This study examined a broad variety of adverse childhood experiences in a consecutive sample of female adolescent inpatients with borderline personality disorder (BPD; n = 44) compared with a clinical control (CC; n = 47) group with mixed psychiatric diagnoses. BPD was diagnosed using a structured clinical interview; different dimensions of childhood adversity were assessed using the Childhood Experiences of Care and Abuse Questionnaire, the Parental Bonding Instrument, and the Family Assessment Device. A history of childhood adversity was significantly more common in patients with BPD than in the CC group. Using a multivariate model, sexual abuse (OR = 13.8), general family functioning (OR = 8.9), and low maternal care (OR = 7.6) were specific and independent predictors of adolescent BPD. The results increase our knowledge of the specific role of different dimensions of childhood adversity in adolescent BPD. They have important implications for prevention and early intervention as they highlight the need for specific strategies for involving the family.

Association of Adolescent Dimensional Borderline Personality Pathology with Past and Current Nonsuicidal Self-Injury and Lifetime Suicidal Behavior: A Clinical Multicenter Study.

Descriptive diagnoses of nonsuicidal self-injury (NSSI) and suicide attempts (SAs) may detract from underlying dimensional borderline personality pathology (D-BPP). This study aimed to investigate D-BPP in adolescent inpatients with NSSI and SAs. A consecutive sample of 359 adolescent inpatients was assessed for current and past NSSI and life-time SAs. D-BPP and current mental health problems were measured using the Dimensional Assessment of Personality Pathology and the Strengths and Difficulties Questionnaire, respectively. D-BPP was significantly associated with both current (p < 0.001) and past NSSI (p = 0.025) and life-time SAs (p < 0.001) compared to their non-self-harming peers. Patients with current and past NSSI did not differ in terms of D-BPP or current mental health problems. A multivariate model did not show any additional influence of current mental health problems over and above D-BPP in predicting NSSI and SAs. It can be hypothesized that D-BPP underlies adolescent self-harm and may persist even after its termination, promoting a higher burden of mental health problems.

3038 – Characteristics of non-suicidal self-injury and suicide attempts among adolescents in europe: results from the european research consortium seyle

Introduction Non-suicidal self-injury (NSSI) is an increasing phenomenon among adolescents. So far, comparable data on prevalence and psychosocial correlates are still rare due to different definitions, study samples, and measures. Aims T o investigate the prevalence and associated psychosocial factors of occasional and repetitive non-suicidal self-injury (NSSI) and its relationship to suicide attempts in a representative adolescent samples from eleven European countries. Methods Cross sectional assessment of adolescents was performed within the European Union funded project, Saving and Empowering Young Lives in Europe (SEYLE), which was conducted in eleven European countries. The representative sample comprised 12,068 adolescents (F/M: 6,717/5,351; mean age: 14.9±0.89) recruited from randomly selected schools. Frequency of NSSI was assessed by a modified version of the Deliberate Self-Harm Inventory (DSHI) and the Paykel Suicide Scale. Additionally, a broad range of demographic, social and psychological factors was assessed. Results Overall lifetime prevalence of NSSI was 27.6%; 19.7% reported occasional NSSI and 7.8% repetitive NSSI. Lifetime prevalence ranged from 17.1% to 38.6% across countries. Suicidality, anxiety and depression had the highest odds ratios for both occasional and repetitive NSSI. Conclusions R esults suggest high lifetime prevalence of NSSI in European adolescents, with significant country differences. A strong association of NSSI with both psychopathology and risk-behaviours, including family-related neglect and peer-related rejection/victimization could be found. These results, combined with the observed gender and country differences, support the need for a multidimensional approach to better understand the development of NSSI and facilitate culturally adapted prevention/intervention.

Der Zusammenhang von Mobbingerfahrungen, Copingstilen und pathologischem Internetgebrauch bei Jugendlichen

OBJECTIVE To investigate the association of pathological internet use, peer victimization, and coping styles among German adolescents who reported experiences of peer victimization. METHOD A cross-sectional survey was conducted within the framework of a European school-based study (SEYLE) which included 1357 representative students (female/male: 710/647; mean age: 14.7; SD = 0.80) from Germany. Pathological internet use was assessed by the Young Diagnostic Questionnaire. Peer victimization was classified into verbal, physical, and relational. Coping style was divided into active, avoidance, help-seeking, and other. Psychological symptoms were assessed as covariate by the Strengths and Difficulties Questionnaire. RESULTS 4.8 % of the students showed pathological internet use, 14.4 % presented with problematic internet use. 52.3 % of the adolescents reported peer victimization (38.7 % verbal victimization, 19.8 % physical victimization, 34.1 % relational victimization). There was a significant association of peer victimization with pathological internet use, which could partly be explained by psychological symptoms. Normal, problematic, und pathological internet users did not differ with regard to their coping styles in relation to victimization. CONCLUSIONS There is an association between peer victimization, psychological symptoms, and pathological internet use. School- and family-based prevention programs and evaluated therapies are needed.

The relationship between bullying experiences, coping style and pathological Internet use among adolescents

OBJECTIVE To investigate the association of pathological internet use, peer victimization, and coping styles among German adolescents who reported experiences of peer victimization. METHOD A cross-sectional survey was conducted within the framework of a European school-based study (SEYLE) which included 1357 representative students (female/male: 710/647; mean age: 14.7; SD = 0.80) from Germany. Pathological internet use was assessed by the Young Diagnostic Questionnaire. Peer victimization was classified into verbal, physical, and relational. Coping style was divided into active, avoidance, help-seeking, and other. Psychological symptoms were assessed as covariate by the Strengths and Difficulties Questionnaire. RESULTS 4.8 % of the students showed pathological internet use, 14.4 % presented with problematic internet use. 52.3 % of the adolescents reported peer victimization (38.7 % verbal victimization, 19.8 % physical victimization, 34.1 % relational victimization). There was a significant association of peer victimization with pathological internet use, which could partly be explained by psychological symptoms. Normal, problematic, und pathological internet users did not differ with regard to their coping styles in relation to victimization. CONCLUSIONS There is an association between peer victimization, psychological symptoms, and pathological internet use. School- and family-based prevention programs and evaluated therapies are needed.

Transgenerational Experiences of Childhood Adversities in the Development of Adolescent Borderline Personality Disorder

Introduction Previous research revealed substantial relations between the experience of childhood adversities and the development of borderline personality disorders (BPD) in adulthood. However, research about antecedents of adolescent BPD is still in its beginnings. Moreover, there is an ongoing controversy regarding transgenerational effects of childhood adversities and potential mediators. Objectives We aim to investigate transgenerational effects of parental childhood experiences on the development of adolescent BPD within the next generation. Hereby, we are focusing on the investigation of differential effects of maternal and paternal experiences of childhood adversities on adolescent BPD and on underlying mechanisms. Methods We consecutively recruited 91 female inpatients ( M age = 15.6 years) from the Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, as well as 87 mothers and 59 fathers. Childhood adversities were assessed for parents and adolescents with the German Childhood Experiences of Care and Abuse Questionnaire, adolescent BPD by means of structured clinical interviews (SKID II). Results Our results are in favor of a transgenerational effect of parental childhood adversities on the development of adolescent BPD. This effect turned out to be stronger for paternal than for maternal childhood adversities. Moreover, paternal childhood adversities revealed to be related to experiences of childhood adversities within the next generation. Conclusions Our results underline the importance of taking the family environment into consideration when developing prevention and treatment programs for adolescent BPD.