Rôle du burnout scolaire dans les idées de suicide des adolescents

Background and study aim

Recent previous studies have highlighted the existence of burnout among high-school students. Burnout among high-school students has been described as a continuum between academic stress and severe burnout. Moreover, as for adults, burnout in school context is a three-dimensional concept that includes: exhausting concerning school demands, cynical attitudes towards school and sense of inadequacy as a student (Salmela-Aro et al., 2009). Previous research has shown that burnout can engender depression (Salmela-Aro et al., 2009), and that, depression in turn could lead to suicide ideas among adolescents (Garlow et al., 2008). Therefore, the aim of this study is to explore the determinisms of burnout among French high-school students and to evaluate the mediator effect of depression between burnout and suicidal ideations.

Method

Two hundred and fifty-six high-school students from 11th and 12th grades participated in this study. Among the participants, 135 were boys and 117 were girls, mean age was 16.9 years (SD = 0.88). The participants completed questionnaires about depression, suicidal ideations, burnout, academic stress, perceived pressure and perfectionism.

Results

Regression analyzes were performed in order to determine the predictor variables of school burnout. The results indicates that burnout was predicted by academic stress, perceived pressure provided by parents and provided by peers; perfectionism however appears as a protective factor. In a second step mediation analyses using multiple regressions were performed. As expected, depression was a mediator between burnout and suicidal ideations. Since burnout was a significant predictor of depression and of suicide ideas, when depression and burnout are both associated, depression is the principal predictor (β = 0.64; t = 11, P < 0.0001) and burnout is no longer a significant predictor (β = –0.09; t = –1.6; P = 0.11). The Sobel post-hoc test confirmed these results (z = 8.4, P < 0.0001).

Conclusion

Therefore it seems important to take into account academic stress and burnout for prevention of suicidality in adolescents. Psychotherapy interventions, focused on problem solving or improving feelings of self-efficacy, may be interesting to explore.     

Tentatives de suicide graves et répétées,et vicissitudes du travail de séparation à l’adolescence. Réflexions théoriques à partir d’un cas clinique

Clinicians who work with hospitalized teenagers often face some young patients’ relentless suicidal determination: these patients seem to have sentenced themselves to death. For several months, sometimes years, no one manages to revoke this incomprehensible capital punishment. This painful conviction that they are unworthy often comes with depressive affects that resist on a long-term basis, despite the combination of antidepressants and a psychotherapeutic approach. Thinking is too stressful: they long to suspend any psychic life, to stop the emergence of any desire and to end any relational impulse. They keep trying to stay in a factitious world, far from real life requirements, as a temporary alternative to death. Through the anaesthesia it produces, the use of drugs offers them a strong protection from their pain. The regressive search for a feeling of lacking psychic differentiation seems to confirm a defect of development within the first phase of the separation individuation process. Narcissistic vulnerability is often underlined in most psychopathological studies concerning suicide attempts during teenage years. Combined with the incapacity to endure any loss, this last element seems to imply that a “relationship of encroachment” exists between the subject and its environment, as well as a persistence of a broad area of lacking differentiation within the maternal imago. From this theoretical point of view, suicidal gestures from these patients are often understood as desperate and paradoxical attempts to reach their boundaries, to maintain their identity and to “withdraw themselves from the object of alienation”. These relevant interpretations hide the “search of a narcissistic state of undifferentiated union” that F. Ladame highlighted during the psychoanalytical counselling of numerous young and seriously suicidal patients. Through this article, we propose to try and re-examine the theoretical concepts related to the ups and downs of the psychic separation work needed by teenagers, particularly for those who went through serious suicide attempts. The presentation of a particularly difficult clinical situation will help us bring context to our subject. The uncompromising posture of this young patient seems to give credence to the hypothesis claiming that the active pursuit of death may be a way to reconnect with an undifferentiated state. In the case of our teenager, everything is going as if his disappearance was the only way to escape from the torments of a separate consciousness, and therefore recover the unconditional love from primary objects through the guise of a fusion fantasy. How can we guide adolescents caught in this narcissistic trap? The therapeutic challenge could be to guide them through the elaboration of the shame attached to their sexual body and of the ambivalent feelings they experience towards their parents. The aim would be to allow them be less dependent on their defensive way to support this deadly quest of symbiotic union with the “primary object”.     

L’usage de Facebook et les enjeux de l’adolescence : une étude qualitative

Objectives

In the last years, a growing concern seems to emerge regarding psychological disturbance that could result from Internet use. Social-networking websites and particularly Facebook are currently very popular and important communication medium for adolescents and young people. This qualitative study focused on adolescents’ investment on their Facebook profile. The aims of this study were: (1) to better understand Facebook use issues among adolescents and young people; (2) to detect conflicts regarding adolescence that might appear on Facebook; (3) and to compare adolescent and young people use.

Method

A semi-structured interview was conducted on 20 adolescents (age ranged from 11 to 21 years old) in order to explore Facebook use as well as parents’ and peers’ relationship. Interviews were transcribed in their entirety and thematic analyses were performed.

Results

Thematic analyses highlighted that adolescents do not use Facebook for creating new intimate relationship, but rather to maintain relationship already existing with peers in offline life and to make social experiment. Adolescence issues appeared through adolescents and parents relationship, and self-image. Some participants reported parental intrusions on their Facebook use, and 35% wanted to protect their intimacy/privacy. Half of the sample posted self-promoting pictures. Furthermore, 70% reported waiting for positive feedbacks when they posted items on Facebook. Four participants reported irrational beliefs linked to “friend's” responses and comments. Facebook use in adolescents is not so different from young people, except for some type of pictures, and for intimacy towards parents.

Conclusion

For adolescents, Facebook is a communication medium used for extending daily relationship and communications. Adolescents do not use this social network to create intimate relationship. It is rather network communications than dyadic relationship. It is a place of social experience, where adolescents experiment rivalry, jealousies, betrayal, and also social support, and positive or negative self-image. Adolescents show on Facebook a particular self-image. Facebook use in adolescents and parental position underline adolescents’ autonomy. However, problematic or inappropriate use of Facebook in adolescents has to be carefully considered. Future research is needed to identify the long-term psychopathological consequences of Facebook use. Longitudinal studies could provide in-depth examination of potential problems, leading to identification and development of preventative strategies.     

L’anorexie mentale chez les adolescents et les jeunes adultes de sexe masculin : recension des écrits

Anorexia nervosa has been the target of many research efforts. However, the latest studies, are mainly focused on female subjects. The literature on males with anorexia nervosa is currently emerging. This review of literature suggests pooling knowledge about male anorexia nervosa that can be extracted from the literature over a period of 15 years. The variables that are specifically targeted are clinical presentation, premorbid conditions, personality characteristics, sexual orientation and activity, gender identity and comorbid troubles. The comparison and the pooling of the results of 24 studies forming the review allow us, in some cases, to support observations made by previous research and to identify certain trends. Among other things, there appears to be similarities between the behavioral symptoms of boys and girls. The review gives a summary of the current knowledge on the various themes of the study concerning male anorexia and emphasizes the plurality and heterogeneity of research methods identifying some areas where further research is needed.     

SociaBillyQuizz,un jeu pour l’entraînement aux habiletés sociales chez l’enfant et l’adolescent : étude exploratoire

Background

The SociaBillyQuizz is a therapeutic game designed for social skills training groups with children and adolescents. Using an entertaining method, this media requests several dimensions: exposure, cognition, communication skills, imagination, emotional expression and sign decoding. In this preliminary study, the setting includes two groups of six adolescents, one with social anxiety disorder and the other with Asperger syndrome.

Objective

To evaluate, in an exploratory study, the effects of a therapeutic device involving this game for these two clinically different groups of adolescents.

Methods

During 26 of 1 hour weekly sessions, two adolescents groups participate to a program including the SociaBillyQuizz and cognitive behavioral therapies. The groups are moderated by two therapists. The SociaBillyQuizz is a board game for two to six players; its goal is to collect points by answering instructions from the different thematic cards. There are four thematic cards: action cards (players have to do something), brainstorming cards (players have to use their imagination and demonstrate cognitive flexibility), interview cards (players have to express themselves about what they think or feel) and mystery cards (unexpected instructions). According to the groups’ clinical characteristics, some aims are specifically highlighted. In the anxiety disorder group, the cognitive dimension is privileged and in the Asperger syndrome group, we emphasise the pretend, cognitive flexibility and theory of mind. The effects are measured by the Rathus Assertiveness Schedule and the Fear Avoidance Hierarchy (FAH) for the social anxiety disorder group and by the Faux Pas Recognition Test and the Social Responsiveness Scale (parent version) for the Asperger group.

Results

These assessment tools indicate, for both groups, a significant increase of the scores corroborating the observed clinical effects. For eleven of the twelve adolescents, a clinical interview 6 months after the retest shows a continuity of therapeutic benefit.

Discussion

These early results suggest that a social skills training device featuring the SociaBillyQuizz produces clinical improvements in these two groups of adolescents. In future researches, with control group and more complete follow-up, nature and effectiveness of its contribution should be specified.

Conclusion

In this preliminary study, the SociaBillyQuizz appears to be an interesting therapeutic tool that can increase implication, motivation, participation and cohesiveness of the group. It also makes easier the cognitive-behavioural-strategies learning.     

La régulation des émotions par le coping chez les enfants et adolescents de sept à 16 ans placés à l’Aide sociale à l’enfance

Objective

The aim of this paper was to compare foster care and typical children's and adolescent's use of emotion regulation processes through coping. Developmental shifts in coping strategies were expected to change coping profiles during the transition from childhood to adolescence and enhance a less adaptive coping style in foster adolescents.

Methods and population

One hundred and forty-two children and adolescents, from 7 to 16 years, participated to this study, 46 were in foster care and 96 were in typical families. Most families lived on medium incomes with a low to medium educational attainment. An Hierarchical Classification Ascendant (method consisting to build a partition of the population into homogeneous clusters [low within-variability] which are different one from another [high between-variability]) was used to identify three coping profiles in children and adolescents: “flexible”, “avoidant”, and “active”. This method allowed us to set up children and adolescent profiles as a function of their ages, their social status and their gender.

Results

It was revealed that 30% of foster care children and adolescents used a “flexible” coping profile in the same proportion as in the control population. In both populations, there was an increase of the adaptive “flexible” coping profile with age. However, a placement in foster families after 6 years old increased adolescents’ vulnerability since between 12 and 16, they used less the “active” coping profile and more the “avoidant” coping style when faced with a stressor. The coping profiles of foster care girls differ significantly from those of girls in typical families with a greater proportion of “avoidant” coping profiles.

Conclusion

These results suggest that the transition from childhood to adolescence alters emotion regulation in both populations. They are discussed within the framework of clinical intervention following the resilience perspective.     

Évaluation de la pensée constructive chez des adolescents et jeunes adultes francophones

Objective

Constructive thinking is defined as the use of functional affective and cognitive coping styles in stressful situations. A first aim of the current study is to evaluate constructive thinking in adolescents and young adults, taking into account gender differences. A second aim is to identify a specific profile of the constructive thinking in delinquent adolescents.

Method

The study comprises two samples. A first sample is constituted of 777 participants of the general population, aged from 12 to 26 years (mean age = 17.09 ± 2.70), recruited in public and private schools, as well as in high-schools and colleges. The second sample is composed of 60 male delinquent adolescents, aged from 12 to 18 years (mean age = 16.15 ± 1.23), recruited in two forensic facilities. All participants were asked to answer the constructive thinking inventory (CTI), a self-report questionnaire assessing the constructive thinking. This self-report questionnaire comprises one global scale, global constructive thinking and six specific scales.

Results

Results of the present study evidence important gender and age differences in coping styles used to handle daily life stressful situations. Specifically, compared to their female counterparts, male participants show a more efficient constructive thinking, with a more black-and-white thinking style, as well as a tendency to consider stressful situations as challenges rather than threats. Regarding age differences, some differences between the adolescents and young adults were observed on some specific scales. Namely, adolescents are more likely to think in a rigid and dichotomous thinking style, and seem to have a simplistic vision of the world, whereas adults are more likely to think in a more realistic way. Finally, compared to male adolescents from the general population, adolescent delinquents show a less efficient constructive thinking. They are less able to display adequate responses to stressful situations and tend to have a more rigid and superstitious thinking.

Conclusion

The CTI appears to be a useful tool to assess adolescents’ and young adults’ strategies to manage daily life problems. Additionally, deficits in constructive thinking seem to play a role in the occurrence and maintenance of delinquent behaviours, and should be taken into consideration for interventions in this specific population.     

Adolescents obèses : évaluation de l’image du corps,de l’estime de soi,de l’anxiété et de la dépression

Background

Adolescence is identified as a critical period for obesity and its complications.

Objective

To evaluate body image, self-esteem, anxiety and depression in obese adolescents.

Methods

Hundred and six obese adolescents benefited from an exploration of body image (Body Prominence, BPQ; Figure Rating Scale, FRS; Questionnaire of Body Preoccupation, QPC), self-esteem (Self-Esteem Scale, SES), anxiety (Revised children Manifest Anxiety Scale, RCMA-S), depression (Center for Epidemiologic studies–Depression Scale, CES-D).

Results

Globally, body image is disturbed. The BPQ shows a level of body consciousness greater in girls. Concerning the choice of the perceived figure, boys position themselves more frequently than girls in plump figures. For wished figures, girls choose more slim figures. However, there is no sex difference concerning body dissatisfaction that is relatively important for both sexes. The QPC indicates that girls have higher body preoccupation level than boys with specific focus on certain body area according to sex. The SES indicates that one out of two adolescents shows a low self-esteem and according to the RCMA-S, one out of three shows a high anxiety level without sex difference. Moreover, from the CES-D, one out of five adolescents, more frequently girls, exhibits a moderate to severe depression.

Conclusion

These results, with a differential interpretation (statistical vs clinical), partly confirm the data from the literature, and underline the need to perform a comprehensive investigation of body image, self-esteem, anxiety and depression in obese adolescents. In order to optimize the quality of the management provided to these youths, we proposed to physicians a pragmatic guide as “the somato-psychic pyramid”. It is important to remind that while escaping from the rule of the body fat regulation, obese adolescents may demonstrate a transgression and an adaptative marginalization.     

Les changements institutionnels amenés par la loi de février 2005 pour l’égalité des droits et des chances,la participation et la citoyenneté des personnes handicapées

First, the author describes the changes produced by the 1975's law. A change of perspective on disability has been the source of the law of February 11, 2005. This has changed the relationship of children with disabilities with the school. In the MDPH, a personalized project of schooling is constructed. The articulation of the role of each stakeholder is taking place gradually. This leads to some important questions. The National Solidarity Fund for Autonomy supports activities that promote this articulation. Some of its actions are focused on assessing the needs of people.     

L’instabilité chez l’enfant : prise en charge institutionnelle et angoisses de séparation

This article aims to understand the child instability with the psychodynamic model. Instability in the child can be explained like resultant, of a defect of interiorization of the maternal imago sufficiently structuring and reassuring. This distortion of the bonds between the mother and the child will take part in a feeling of insecurity interns and an absence of narcissistic solidity, which will result a separation anxieties of separation. Its actions and movements have thus as a function to maintain the contact with the others, while seeking to differ from their psychic spaces. As part of this article, we present a child of an 8-year-old take care of by Educational and Teaching Therapeutic Institute (ITEP). After a first period of adaptation and familiarisation with the institution, the child tends to reproduce with the professionals the same behaviors as those, which it develops with his family. The healthcare, in particular in ITEP, the heathcare institution relies upon the family work to keep a framework. The framework contains the very archaic sufferings of the child. Some behaviors could be apprehended like a disturbance of the psychic envelopes of the child. Thus, we will observe through the problems separation how psychic work between the child and his parents can go back moving.     

Effets cérébraux du binge drinking chez les jeunes : l’éclairage des neurosciences

The frequency and intensity of alcohol consumption episodes has rapidly increased among adolescents and young adults during the last decade. Particularly, binge drinking habits, globally defined as an alcohol consumption pattern characterized by excessive but episodic alcohol intakes with an alternation between intense intoxications episodes and withdrawal periods, have recently expanded towards younger populations. These alcohol-related problems in youth are now considered as a central public health concern in Western countries. The psychological, interpersonal and social problems associated with binge drinking are now well established, but the cerebral correlates of this habit remain poorly understood. Animal studies have suggested that binge drinking might rapidly lead to large-scale cerebral impairments, notably because the immature adolescent brain is particularly sensitive to alcohol effects and because the repeated alternation between intoxications and withdrawals is particularly deleterious for the brain. However, this proposal has up to now received only limited support from human studies. On the basis of a precise definition of binge drinking, the present paper thus centrally aims at reviewing the current knowledge concerning brain impairments observed among binge drinkers, and at proposing a potential research agenda to favour the development of this topic in the following years. Recent data obtained by means of neuropsychological, electrophysiological and neuroimaging techniques will first be presented, before identifying the crucial yet still underexplored questions to be investigated in this research field, and particularly: (1) the specificity of the deficits for binge drinking as compared to other alcohol consumption patterns; (2) the age and gender variations concerning the brain effects related to excessive alcohol consumption; (3) the causal link between cerebral impairments and binge drinking habits, with the proposal that some brain changes might precede the appearance of binge drinking; (4) the continuity between the successive stages of alcohol-related problems, from alcohol abuse in binge drinking to alcohol-dependence; (5) the proposal that a cerebral compensation might take place in the first stages of binge drinking, some brain regions being activated during cognitive tasks to compensate for altered activations in other brain areas. Finally, the major implications that could be allowed by a better understanding of this issue at theoretical and clinical points of view will be underlined. A particular emphasis will be put on the critical need to rapidly develop a combined neuroscience approach in order to further identify the structural and functional effects of binge drinking habits on the brain.