Jonas Bjärehed

Self-reported emotional and behavioral problems in Swedish 14 to 15-year-old adolescents: A study with the self-report version of the Strengths and Difficulties Questionnaire

The psychometric properties of the Swedish self-report version of the Strengths and Difficulties Questionnaire (SDQ-s), and the prevalence of emotional and behavioral problems as measured by the SDQ-s, were studied in 14 to 15-year-old adolescents. The psychometric properties were found to be similar to those found in other language versions, in terms of similar factor structure and acceptable test-retest stability, but low internal consistencies for some of the subscales. There was evidence of good convergent and discriminant validity. The results with regard to gender differences replicated previous findings in other countries, the girls reporting more emotional symptoms and more prosocial behavior, and the boys reporting more conduct problems and tending to report more peer problems. It is concluded that the results are in favor of using the Swedish SDQ-s as a screening instrument for adolescents, despite the low internal consistencies of some of its subscales.

Internet administered guided self-help versus individualized e-mail therapy: A randomized trial of two versions of CBT for major depression

Internet-delivered psychological treatment of major depression has been investigated in several trials, but the role of personalized treatment is less investigated. Studies suggest that guidance is important and that automated computerized programmes without therapist support are less effective. Individualized e-mail therapy for depression has not been studied in a controlled trial. Eighty-eight individuals with major depression were randomized to two different forms of Internet-delivered cognitive behaviour therapy (CBT), or to a waiting-list control group. One form of Internet treatment consisted of guided self-help, with weekly modules and homework assignments. Standard CBT components were presented and brief support was provided during the treatment. The other group received e-mail therapy, which was tailored and did not use the self-help texts i.e., all e-mails were written for the unique patient. Both treatments lasted for 8 weeks. In the guided self-help 93% completed (27/29) and in the e-mail therapy 96% (29/30) completed the posttreatment assessment. Results showed significant symptom reductions in both treatment groups with moderate to large effect sizes. At posttreatment 34.5% of the guided self-help group and 30% of the e-mail therapy group reached the criteria of high-end-state functioning (Beck Depression Inventory score below 9). At six-month follow-up the corresponding figures were 47.4% and 43.3%. Overall, the difference between guided self-help and e-mail therapy was small, but in favour of the latter. These findings indicate that both guided self-help and individualized e-mail therapy can be effective.

Deliberate Self‐Harm in 14‐Year‐Old Adolescents: How Frequent Is It, and How Is It Associated with Psychopathology, Relationship Variables, and Styles of Emotional Regulation?

Deliberate self‐harm was studied in 14‐year‐old adolescents from four schools in southern Sweden with a test–retest design, using a nine‐item version of the Deliberate Self‐Harm Inventory. At Time 1, 40.2% of the adolescents indicated deliberate self‐harm on at least one occasion compared with 36.5% at Time 2. Test–retest data showed high stability over periods of up to 2 months in duration. Cross‐validation of the results from Time 1 to Time 2 showed robust correlations between deliberate self‐harm and general psychopathology, a relative absence of positive feelings toward parents, and a ruminative style of emotional regulation. Further, rumination/negative thinking and a relative absence of positive feelings toward parents were predictors of self‐harm independently of general psychopathology. In addition, deliberate self‐harm correlated with symptoms of eating disorder and negative body esteem in girls.

Deliberate self-harm and psychological problems in young adolescents: Evidence of a bidirectional relationship in girls

The purpose of this study was to test the hypotheses that there is a bidirectional prospective relationship between mental health and deliberate self-harm, in the sense that (1) psychological problems are a risk factor for the development of self-harm; (2) self-harm is a risk factor for the development of psychological problems; and (3) the relative absence of psychological problems is a protective factor against the continued use of self-harm in adolescents who have started to harm themselves. This was studied in a community sample of 879 young adolescents by means of a 2-wave longitudinal design with a one-year interval, with self-harm measured by a nine-item version of the Deliberate Self-Harm Inventory (DSHI-9r) and psychological problems by the self-report version of the Strengths and Difficulties Questionnaire (SDQ). The hypothesis of bidirectional relationship between psychological problems and self-harm was supported among girls, but not among boys - although there was evidence of psychological problems as a risk factor of self-harm in boys, the converse was not the case. The relative absence of psychological problems was found to be a protective factor against self-harm only among boys, but not among girls. The results are discussed in terms of self-harm having a different role in the development of psychopathology among girls than among boys.

Less positive or more negative? Future-directed thinking in mild to moderate depression

Abstract Depressed patients have been found to generate fewer anticipated positive future events, but most previous studies have included patients who have either been severely depressed or expressed suicidal thoughts and intents or both. The aim of this study was to compare positive and negative future-directed thinking in persons with mild to moderate depression who did not express suicidal thoughts or intents (n = 20) with a matched group of nondepressed persons (n = 20). The two groups completed the Future-Thinking Task (FTT), in which they were asked to generate positive and negative anticipated future events for three upcoming time periods (1 week, 1 year, and 5–10 years). In the present version of the FTT, both quantitative and qualitative aspects were included (i.e. subjective likelihood and emotional valence). Results showed that depressed persons reported lower scores regarding anticipated future positive events but they did not differ in terms of future negative events. The results are consistent with previous research and further strengthen the notion that reduced anticipation of future positive events is a defining characteristic of depression, even in the absence of suicidal ideation.

Depressive Symptoms and Deliberate Self-Harm in a Community Sample of Adolescents: A Prospective Study

The associations between depressive symptoms and deliberate self-harm were studied by means of a 2-wave longitudinal design in a community sample of 1052 young adolescents, with longitudinal data for 83.6% of the sample. Evidence was found for a bidirectional relationship in girls, with depressive symptoms being a risk factor for increased self-harm one year later and self-harm a risk factor for increased depressive symptoms. Cluster analysis of profiles of depressive symptoms led to the identification of two clusters with clear depressive profiles (one severe, the other mild/moderate) which were both characterized by an overrepresentation of girls and elevated levels of self-harm. Clusters with more circumscribed problems were also identified; of these, significantly increased levels of self-harm were found in a cluster characterized by negative self-image and in a cluster characterized by dysphoric relations to parents. It is suggested that self-harm serves more to regulate negative self-related feelings than sadness.

Examining the Acceptability, Attractiveness, and Effects of a School-Based Validating Interview for Adolescents Who Self-Injure

Nonsuicidal self-injury (NSSI) in adolescents is a significant problem that needs to be addressed, and in some cases managed, in school settings. The current feasibility study uses screening questionnaires and follow up-interviews on NSSI in a community sample of adolescents (N = 1,052) in Sweden. Both adolescents reporting self-injury (n = 66) and a comparison group (n = 31) were interviewed, and information disclosed about self-injury, as well as the results from the interviewers assessments of the seriousness of these behaviors, were examined. Generally, adolescents reported positive feelings about being interviewed, and 52% of those who had reported self-injury in the questionnaire disclosed NSSI in the interviews. Further, a majority of these cases, 76%, were not assessed as very serious. When NSSI was reported in a questionnaire 1 year after the interview, there were no indications of iatrogenic effects from participating in the interview. The results support the feasibility of using NSSI screening questionnaires in combination with follow-up interviews in schools.

Emotion regulation group therapy for deliberate self-harm: A multi-site evaluation in routine care using an uncontrolled open trial design

Objective Emotion regulation group therapy (ERGT) has shown promising results in several efficacy trials. However, it has not been evaluated outside a research setting. In order to increase the availability of empirically supported treatments for individuals with borderline personality disorder and deliberate self-harm, an evaluation of ERGT in routine clinical care was conducted with therapists of different professional backgrounds who had received brief intensive training in ERGT prior to trial onset. Design Multi-site evaluation, using an uncontrolled open trial design with assessments at pretreatment, post-treatment and 6-month follow-up. Setting 14 adult outpatient psychiatric clinics across Sweden. Participants Ninety-five women (mean age=25.1 years) with borderline personality disorder (both threshold and subthreshold) and repeated self-harm were enrolled in the study. Ninety-three per cent of participants completed the post-treatment assessment and 88% completed the follow-up assessment. Primary and secondary outcome measures Primary outcome was self-harm frequency as measured with the Deliberate Self-Harm Inventory. Secondary outcomes included self-harm versatility, emotion dysregulation, other self-destructive behaviours, depression, anxiety, stress symptoms and interpersonal and vocational difficulties. Intervention ERGT is an adjunctive, 14-week, acceptance-based behavioural group treatment that directly targets both self-harm and its proposed underlying mechanism of emotion dysregulation. Results At post-treatment, intent-to-treat analyses revealed a significant improvement associated with a moderate effect size on the primary outcome of self-harm frequency (51%, reduction; Cohen’s d=0.52, p<0.001) as well as significant improvements in the secondary outcomes of self-harm versatility, emotion dysregulation, other self-destructive behaviours and general psychiatric symptomatology. These results were either maintained or further improved on at 6-month follow-up. Conclusions ERGT appears to be a feasible, transportable and useful treatment for deliberate self-harm and other self-destructive behaviours, emotion dysregulation and psychiatric symptoms when delivered by clinicians in the community. Trial registration number NCT01986257; results.

Predictors of improvement in an open-trial multisite evaluation of emotion regulation group therapy

ABSTRACT Emotion regulation group therapy (ERGT) is a novel treatment specifically targeting deliberate non-suicidal self-harm (DSH) in individuals with borderline personality disorder (BPD). Identifying robust predictors of positive response to ERGT could aid clinicians in treatment selection; however, to date, only one such study has been conducted. Thus, we aimed to replicate previously identified predictors of treatment response to ERGT by investigating demographic, clinical, and diagnostic predictors in 95 women with BPD or subclinical BPD who had participated in an open-trial evaluation of ERGT. Outcomes evaluated were frequency of DSH and emotion dysregulation. Assessments were conducted at pretreatment, post-treatment, and 6-month follow-up. Multilevel mixed linear models and multilevel negative binomial generalized estimated equations were used to identify significant interactions between the predictors and outcomes. We found that greater pretreatment DSH frequency was associated with greater improvements in DSH during treatment (b = 0.998, SE = 0.00, p = 0.03) and follow-up (b = 0.997, SE = 0.00, p < 0.01) and that greater BPD severity was associated with greater improvements in DSH during treatment (b = 0.84, SE = 0.06, p = 0.02) and in emotion dysregulation at follow-up (b = −3.05, SE = 1.47, p = 0.04). Co-occurring disorders were associated with poorer treatment response during follow-up. Results were generally consistent with a previous study of the predictors of response to ERGT. The findings provide further support for the utility of this treatment across a range of BPD patients, including patients with severe DSH and BPD.