Brief admission by self-referral as an add-on to usual care for individuals with self-harm at risk of suicide: cost-effectiveness and 4-year health-economic consequences after a Swedish randomized controlled trial.

BACKGROUND: Brief Admission by self-referral (BA) is a crisis-management intervention standardized for individuals with self-harm at risk of suicide. We analyzed its health-economic consequences. MATERIALS AND METHODS: BA plus treatment as usual (TAU) was compared with TAU alone in a 12-month randomized controlled trial with 117 participants regarding costs for hospital admissions, coercive measures, emergency care and health outcomes (quality-adjusted life years; QALYs). Participants were followed from 12 months before baseline to up to five years after. RESULTS: Over one year BA was associated with a mean annual cost reduction of 4800 or incremental cost of 4600 euros, depending on bed occupancy assumption. Cost-savings were greatest for individuals with >180 admission days in the year before baseline. In terms of health outcomes BA was associated with a QALY gain of 0.078. Uncertainty analyses indicated a significant QALY gain and ambiguity in costs, resulting in BA either dominating TAU or costing 59 000 euros per gained QALY. CONCLUSION: BA is likely to produce QALY gains for individuals living with self-harm and suicidality. Cost-effectiveness depends on targeting high-need individuals and comparable bed utilization between BA and other psychiatric admissions. Future research should elaborate the explanatory factors for individual variations in the usage and benefit of BA.

Evaluating the psychometric properties of the Swedish version of the Impostor Profile scale (IPP30).

The Impostor Profile scale (IPP30) is a recently developed tool designed to delve into the nuanced aspects of the Impostor Phenomenon (IP), a psychological phenomenon where individuals wrongly attribute their successes to external factors, discounting their own abilities and often feeling like frauds. This study aimed to assess the psychometric properties, including factor structure, internal consistency, and nomological validity, of the Swedish version of IPP30 (S-IPP30). In a sample of Swedish students (N = 1,010; 76.7% women; Mage = 25.65, SDage = 6.43), Exploratory and Confirmatory Factor Analyses were conducted to scrutinize S-IPP30's structure. The analyses supported a bifactor model with six specific factors and one overarching factor. However, two items in the scale displayed poor alignment with their intended subscales, adversely affecting the internal consistency of the two subscales. Consequently, a rephrasing of these items was suggested. The remaining four S-IPP30 subscales exhibited good internal consistency (Cronbach's α = 0.76-0.90, McDonald's ω = 0.77-0.91). Convergent validity was confirmed by largely replicating correlations among various S-IPP30 facets, the unidimensional IP measure, personality variables, and self-esteem, thereby accomplishing the goal of validating S-IPP30. This proposed modification of the two items requires further validation using a new sample to ensure its appropriateness and effectiveness in measuring the intended constructs.

Disordered eating in a 10-year perspective from adolescence to young adulthood: Stability, change, and body dissatisfaction as a predictor.

INTRODUCTION: Although there are many studies of disordered eating (DE) in adolescence, studies examining the longitudinal stability and change of DE and its longitudinal associations with other factors are still rather scarce. Such studies are important to inform parents and clinicians how stable DE is and to what extent it will go away with increased maturity. Longitudinal studies may also be of help in establishing predictors of long-term problems. The purpose of the present study was to investigate the stability of DE over a 10-year period from early adolescence to young adulthood, and to explore body dissatisfaction as a predictor in a 10-year perspective. METHODS: Data were taken from a three-wave longitudinal project (SoL) with survey data collected among the students in Grades 7and 8 in a Swedish municipality in 2007 (T1), 1 year later (T2), and in a 10-year follow-up in 2017 (T3). DE was measured by the eight-item version of the Risk Behaviour Related to Eating Disorders (RiBED-8), and a quasi-clinical criterion of six or more critical answers on the RiBED-8 was used to classify DE cases. RESULTS: Of the girls, 5.8% passed the cutoff for DE at T1, whereas 9.1% did so at T2 and 7.9% at T3. The boys showed markedly lower figures: 0.5% both at T1 and T2, and 1.5% at T3. There was significant individual stability of DE over the 10-year period, with almost 30% of the girls who passed the cutoff for DE at T1 also doing so 10 years later. Body dissatisfaction in early adolescence predicted the incidence of new cases of DE 10 years later, even when controlling for degree of DE in early adolescence. The results also indicate that DE in early adolescence may be a passing phase among adolescents who express relatively high body satisfaction. CONCLUSIONS: The present results show a complex picture of different individual trajectories of DE, with degree of body satisfaction playing a significant role for the outcome in a 10-year perspective. Body dissatisfaction appears to be a risk factor for the development of new cases of DE, whereas body satisfaction may protect against the continuation of DE into adulthood.

Adolescents' Emotion Regulation Strategies Questionnaire-Extended: Further Development and Associations With Mental Health Problems in Adolescence.

Emotion regulation (ER) is implicated in a range of psychopathologies and behavioral problems that are prevalent or have their initial onset in adolescence. In this study, we aim to evaluate the psychometric properties (factor structure, internal consistency, and construct validity) of the Adolescents' Emotion Regulation Strategies Questionnaire-Extended (AERSQ-E), a modified and extended version of an ER instrument developed by Zhou et al. Across six sub-studies using data from different Swedish adolescent community samples (1,104 students in total), we generated and validated a 23-item version containing six subscales: rumination/negative thinking, positive reorientation, creative expression, aggressive outlet, social support, and distraction. Assessing test-retest reliability, internal consistency, measurement invariance as well as convergent and discriminant validity, we could establish, with some limitations, the general reliability and validity of the AERSQ-E as a valid measure of ER strategies for use in adolescence.

Developmental pathways of repetitive non-suicidal self-injury: predictors in adolescence and psychological outcomes in young adulthood.

BACKGROUND: Much longitudinal research has been carried out on non-suicidal self-injury (NSSI) during the last decades, but there still is a lack of studies of the individual developmental pathways of NSSI from adolescence into young adulthood. The aim of the present study was to investigate individual developmental pathways of repetitive non-suicidal self-injury (repNSSI) from adolescence into young adulthood, including adolescent predictors and psychological outcomes in young adulthood. Three developmental pathways were targeted: stable adolescence-limited repNSSI; repNSSI prolonged into young adulthood; and late-onset repNSSI; with no repNSSI as comparison. METHODS: Data were taken from a cohort of compulsory school students (N = 1064) in grades 7-8 in a Swedish municipality. The cohort was followed longitudinally, and this study included all individuals (n = 475) with NSSI data from three waves: T1 (when they were 13-15 years old); T2 (one year later); and T3 (ten years later). RepNSSI was operationalized as self-reports of at least 5 instances of NSSI during the past six/twelve months. RESULTS: The two pathways that involved stable repNSSI were observed significantly more often than expected by chance, with the strongest overrepresentation for the Prolonged RepNSSI pathway. Still, most adolescents who engaged in stable repNSSI stopped this before reaching young adulthood. Those who stopped did not, however, show a significantly better psychological adjustment in young adulthood than those who continued. Compared to participants with no repNSSI, participants who had stopped still reported significantly more stress, anxiety, and emotional dysregulation. As to the prediction of late onset NSSI, the findings were less robust, but sporadic NSSI at T1 and poor sleep at T2 were significant predictors, whereas depressive symptoms fell just short of significance at both timepoints. CONCLUSIONS: The present results indicate that among adolescents who engage in stable adolescent repNSSI (1) significantly more individuals than expected by chance still engage in repNSSI ten years later, and (2) those who stop engaging in repNSSI do not show significantly better psychological adjustment than those who still engage in it. The present findings also indicate that late onset of repNSSI as reported in young adulthood to some extent is predictable from symptom measures ten years earlier.

Everyday executive functioning in pediatric obsessive-compulsive disorder: diagnostic specificity, clinical correlations, and outcome.

BACKGROUND: Obsessive-compulsive disorder (OCD) typically onsets during childhood or adolescence and difficulties with executive functioning (EF) may be involved in its onset and maintenance. Yet, few studies have examined everyday EF difficulties in youth with OCD and no study has compared EF in youth with OCD to EF in youth with anxiety disorders, leaving the diagnostic specificity of EF unclear. METHODS: In this study, parents of treatment-seeking children and adolescents with OCD (n = 96, Mage = 13.3, SD = 2.7, 59% girls) or anxiety disorders (n = 67, Mage = 14.0, SD = 2.6, 78% girls) reported on their children's everyday EF using the Behavior Rating Inventory of Executive Function (BRIEF) measure. RESULTS: Compared to community youth, the two clinical groups showed moderately elevated EF deficits but did not differ significantly from each other. EF deficits were not associated with the major symptom dimensions of OCD, age of OCD symptom onset, duration of OCD symptoms, and OCD severity, and did not predict treatment outcome in OCD. CONCLUSIONS: Compared to peers, youth with OCD show moderate difficulties with EF, but very similar difficulties are seen in youth with anxiety disorders, and it is unclear whether these difficulties are of clinical relevance. Among youth with OCD, EF difficulties were not differentially associated with the major symptom dimensions of OCD, which is inconsistent with findings from adults. Difficulties with EF did not predict treatment outcome, indicating that integrating EF modules into OCD treatment may be of limited value, although EF may be important for treatment planning in individual cases.

A validation of the Swedish self-concept and Identity Measure (SCIM) and its association with mental health problems.

Pathological disturbance to one's identity is closely linked with mental illness and in particular personality disorders. Current measures of identity pathology within clinical research are nevertheless inconsistently used and present with substantial limitations such as disproportionate focus on adolescence. The Self-Concept and Identity Measure (SCIM) identifies pathological and non-pathological identity disturbance by implementing a measurement for clinical components of identity, as well as introducing the Lack of Identity concept. This study thus explores the psychometric properties (factor structure, internal consistency, and criterion validity) of the Swedish SCIM in a large sample of Swedish university students (N = 1500). Model fit indices for the three-dimension model of identity pathology consisting of consolidated-, disturbed-, and lack of identity subscales were deemed acceptable and the Swedish SCIM scores correlated with measures of psychopathology in the expected direction, together concluding that the Swedish SCIM was satisfactorily valid and reliable. The results further reveal a significant positive correlation between identity pathology and non-suicidal self-injury, two concepts that co-occur in psychopathologies, such as borderline personality disorder, but have not yet been studied in a Western population with this tool. The potential clinical use of this translated dimensional tool needs to be tested in a Swedish clinical population, however, we conclude that it already offers insight into the complexities of identity functioning and correlations with clinical symptoms.

Off track or on? Associations of positive and negative life events with the continuation versus cessation of repetitive adolescent nonsuicidal self-injury.

OBJECTIVE: This study examined how patterns of repetitive (≥5 instances) nonsuicidal self-injury (NSSI) associate with measures of resilience and life events retrospectively reported to have occurred within the last year, 1 to <5 years ago, and 5 to <10 years ago. METHOD: Life events reported by 557 young adults (mean [SD] age 25.3 [0.68]; 59.2% women) were classified as positive, negative, or profoundly negative based on their relationship to participants' mental health and well-being. We subsequently examined how these categories, together with resilience, were cross-sectionally associated with reporting no NSSI, and the (full/partial) cessation/continuation of repetitive NSSI from adolescence to young adulthood. RESULTS: Repetitive NSSI in adolescence was associated with (profoundly) negative life events. Relative to cessation, NSSI continuation was significantly associated with more kinds of negative life events (odds ratio [OR] = 1.79) and fewer kinds of positive life events 1 to <5 years ago (OR = 0.65) and tended to be associated with lower resilience (b = -0.63, p = 0.056). Neither life events nor resilience significantly differentiated individuals reporting full or partial cessation. CONCLUSION: Resilience appears important for the cessation of repetitive NSSI, but contextual factors must still be considered. Assessing positive life events in future studies holds promise.

The five self-harm behavior groupings measure: empirical and thematic data from a novel comprehensive self-harm assessment.

Introduction: The Five Self-Harm Behavior Groupings Measure (5S-HM) is a novel assessment that evaluates behaviours which may go undetected by existing measures. Self-harm is formulated across directness and lethality spectra, including under-studied behaviors such as indirect self-harm, harmful self-neglect and sexual self-harm. Aims of the study were to: (1) empirically evaluate the 5S-HM; (2) to determine whether the 5S-HM generates relevant new information with respect to the forms and functions given by participants for self-harm within a clinical sample; (3) to test the utility and novel contributions of the Unified Model of Self-Harm and the 5S-HM by extension. Methods: Data were collected from N = 199 individuals (Mage = 29.98, SD = 8.41, 86.4% female), receiving specialized evidence-based treatments for self-harm, borderline personality disorder or eating disorders. Construct validity was determined via Spearman correlations, and internal consistency was established from Cronbach's alpha. Inductive thematic analysis was used to analyze and interpret qualitative data on reasons, forms and functions participants reported in relation to self-harm following Braun and Clarke's analytic guidelines. Thematic mapping was used to summarize qualitative data. Results: Test-retest reliability on a subsample of n = 24, tested 14 days after Time 1 was supported by a good intraclass correlation (0.68). Internal consistency (Cronbach's alpha = 0.75) was acceptable to good, as was construct validity comparing the 5S-HM total score to two validated self-harm measures (rho = 0.40, p < 0.01; rho = 0.26, p < 0.01). A thematic map depicting antecedents and consequences of self-harm over time suggests that self-harm is initiated by negative emotional states and self-intolerance. Novel findings in relation to sexual self-harm indicated that reasons for these behaviors were either to improve or worsen one's situation through being hurt by someone else. Discussion: The empirical analyses of the 5S-HM demonstrate that it is a robust measure for use in clinical and research settings. Thematic analyses proposed explanations for why self-harm behaviors are initiated and how they are reinforced over time. Sexual self-harm in particular requires further careful study.

Profiles of Achievement Motivation and Performance in Middle School: Links to Student Background and Perceived Classroom Climate.

Achievement motivation and performance at school are reciprocally related, however, empirical studies report a large variability of findings and, in some cases, weaker than expected associations between these constructs. To further our understanding of the motivation-performance link, we examined typical patterns of motivation and performance and their correlates, in two cohorts of 8th-grade students (N 1 = 998, N 2 = 441). As expected, we identified both concordant and discordant patterns of achievement motivation and performance. In two subgroups, specifically, those characterized by low motivation and low performance (34% of the sample) and those characterized by high motivation and high performance (18% of the sample), the levels of motivation were highly concordant with scores on math and reading tests. In contrast, the other two profiles-weak motivation with elevated performance (38% of all sample) and high motivation with low performance (9% of the sample) had divergent patterns of motivation and performance. The subgroups also differed on student socio-economic background, special educational needs, gender, as well as perceptions of classroom climate. Overall, our findings reveal context-dependent patterns of the relationship between aspects of achievement motivation and performance.

"What I couldn't do before, I can do now": Narrations of agentic shifts and psychological growth by young adults reporting discontinuation of self-injury since adolescence.

PURPOSE: We explore young adults' narrations of life events in association with nonsuicidal self-injury (NSSI) discontinuation, psychological growth, and agency. METHODS: Transcripts from eleven face-to-face interviews with individuals who quantitatively reported injuring themselves in adolescence (2007-2008) but not in young adulthood (2017) were narratively analysed. RESULTS: We found that at starting points, a period preceding an agentic shift in the narrative, participants endured stressful living conditions and mental illness. During this period, participants perceived no point in trying to initiate change because they did not perceive themselves as having the capacity to do so and nor could they adequately utilize any formal or informal support. After a turning point that enabled agency due to gaining a sense of belongingness, liberation, or perspective, participants underwent a process of attaining psychological well-being. However, narrating psychological growth also required momentum points, encompassing the management of and moving on from stressful contexts, along with the recognition of milestones marking improvement relative to the starting points. CONCLUSIONS: NSSI discontinuation was narrated in conjunction with psychological growth when participants also experienced themselves as situated within an agentic context, because agency is understood as necessary to react to and manage current and future life circumstances.

Testing the psychometric properties of the Swedish version of the EPOCH measure of adolescent well-being.

The EPOCH Measure of Adolescent Well-being measures five positive indicators of the well-being of adolescents: engagement, perseverance, optimism, connectedness and happiness. This five-factor structure along with other indicators of validity and reliability were supported for the original English version and the Chinese version. In this study, we tested the psychometric properties of the Swedish version of the EPOCH with a sample (n = 846) of Swedish high school adolescents aged 16-21 years (Mage = 18, SD = .85). The participants answered a questionnaire containing the EPOCH, Coping Self-Efficacy Scale, and 21-item Depression, Anxiety, and Stress Scale (DASS-21). A confirmatory factor analysis supported a the five-factor, inter-correlated model. The internal consistency was good for all the EPOCH subscales (Cronbach's α = .76-.88, McDonald's ω = .77 -.88). The criterion validity was established by replicating correlations between the five EPOCH subscales and positive (coping self-efficacy) and negative (DASS-21) aspects of well-being. This study shows that the Swedish version of the EPOCH is suitable for assessing multiple dimensions of adolescent well-being.

Corrigendum: Revisiting the Organismic Valuing Process Theory of Personal Growth: A Theoretical Review of Rogers and Its Connection to Positive Psychology.

[This corrects the article DOI: 10.3389/fpsyg.2020.01706.].

Computational Language Assessments of Harmony in Life - Not Satisfaction With Life or Rating Scales - Correlate With Cooperative Behaviors.

Different types of well-being are likely to be associated with different kinds of behaviors. The first objective of this study was, from a subjective well-being perspective, to examine whether harmony in life and satisfaction with life are related differently to cooperative behaviors depending on individuals' social value orientation. The second objective was, from a methodological perspective, to examine whether language-based assessments called computational language assessments (CLA), which enable respondents to answer with words that are analyzed using natural language processing, demonstrate stronger correlations with cooperation than traditional rating scales. Participants reported their harmony in life, satisfaction with life, and social value orientation before taking part in an online cooperative task. The results show that the CLA of overall harmony in life correlated with cooperation (all participants: r = 0.18, p < 0.05, n = 181) and that this was particularly true for prosocial participants (r = 0.35, p < 0.001, n = 96), whereas rating scales were not correlated (p > 0.05). No significant correlations (measured by the CLA or traditional rating scales) were found between satisfaction with life and cooperation. In conclusion, our study reveals an important behavioral difference between different types of subjective well-being. To our knowledge, this is the first study supporting the validity of self-reported CLA over traditional rating scales in relation to actual behaviors.

What happens to young adults who have engaged in self-injurious behavior as adolescents? A 10-year follow-up.

This study examined the longitudinal associations between non-suicidal self-injury (NSSI) in early adolescence and various positive and negative aspects of mental health in young adulthood. The participants were a cohort of regular school students (n = 1064) in grades 7-8 from a Swedish municipality. Nine hundred and ninety-one of these completed an 11-page questionnaire (T1: Mage = 13.7; 50.3% girls); 1 year later, 984 students completed the questionnaire again (T2: Mage = 14.8; 51.1% girls); and 10 years later, 557 took part (T3: Mage = 25.3; 59.2% women). The prevalence of any NSSI (≥ 1 instance) decreased from about 40% in adolescence to 18.7% in young adulthood, while the prevalence of repetitive NSSI (≥ 5 instances) decreased from about 18 to 10%. Compared to individuals who reported no NSSI as adolescents, and controlling for gender and psychological difficulties in adolescence, adolescents with stable repetitive NSSI (i.e., repetitive NSSI at both T1 and T2) showed significantly higher levels of stress, anxiety, NSSI, and difficulties in emotion regulation 10 years later. Even infrequent and unstable repetitive NSSI in adolescence was associated with negative outcomes in young adulthood. These results suggest that stable repetitive NSSI in adolescence is a strong risk factor for mental health problems in young adulthood and that occasional engagement in NSSI in adolescence is an indicator of vulnerability for poorer mental health in young adulthood.

Revisiting the Organismic Valuing Process Theory of Personal Growth: A Theoretical Review of Rogers and Its Connection to Positive Psychology.

Humanistic and positive psychology have had a contentious past. Initially, positive psychology researchers have distanced themselves from humanistic psychology, proceeding to build an array of differentiated constructs relevant to an empirical study of well-being. Twenty years on, it is now generally acknowledged that humanistic psychology is the theoretical predecessor of positive psychology in terms of holistic growth theories. In this theoretical review, we aim to show how Carl Rogers' organismic valuing process (OVP) theory can serve as a holistic framework for individual positive psychological research findings and theories and how positive psychology, in turn, provides empirical support for this meta-theoretical framework. An important motivation for considering personal growth as a process that integrates various aspects of well-being is theoretical integration, which can help us better understand how well-being develops in individuals across the lifespan. Some theoretical and practical implications of incorporating OVP theory into well-being research are also suggested.

One-Year Consistency in Lifetime Frequency Estimates and Functions of Non-Suicidal Self-Injury in a Clinical Sample.

Non-suicidal self-injury (NSSI), the direct, deliberate destruction of one's own bodily tissue in the absence of an intent to die, is frequently used for evaluating treatment in clinical care. One instrument for assessing NSSI is the Inventory of Statements About Self-Injury (ISAS). The ISAS is a self-rating measure examining the lifetime frequencies of NSSI behaviors and further exploring NSSI functions. The study aimed to examine the consistency of self-reported lifetime NSSI frequencies and functions (via the ISAS) in a clinical sample of individuals with current self-harm and/or recurrent suicidal behaviors over one year. Fifty-two individuals (84.6% women) completed the ISAS three times over 1 year. We found relatively good test-retest stability for most NSSI behaviors and functions, but the correlation coefficients and frequencies of NSSI behaviors varied substantially. Approximately, 50% of participants reported lower lifetime frequencies of NSSI behaviors at the later time points, with approximately 20% reporting a significant reduction in their lifetime frequencies over one year. This unexpected finding raises concerns about the accuracy of reporting lifetime NSSI frequencies among individuals with multiple psychiatric diagnoses and extensive NSSI behaviors across their lives. Further research is needed to determine more reliable ways of collecting data on the lifetime frequency of NSSI in clinical samples and the accuracy of lifetime NSSI frequency estimates in general.

Adolescents' Emotion Regulation Strategies Questionnaire: Initial Validation and Prospective Associations With Nonsuicidal Self-Injury and Other Mental Health Problems in Adolescence and Young Adulthood in a Swedish Youth Cohort.

Although there is extensive research indicating the vital role of functional emotion regulation (ER) in healthy psychological development, such research has neglected examination of adolescents. One potential reason for this neglect is the lack of valid ER instruments developed specifically for adolescents. Further, the available ER instruments for adolescents usually require elaborate forms of cognitive reasoning about the internal sequences of cognitions and emotions. To address these limitations, we developed the Adolescents' Emotion Regulation Strategies Questionnaire (AERSQ), a self-report instrument of adolescents' commonly used ER strategies in daily life and examined its psychometric characteristics in a 10-year, three-wave cohort of Swedish youths (original N = 991, mean age = 13.7, 14.8, and 25.3 at waves 1, 2, and 3, respectively). Exploratory (wave 1 data) and confirmatory (wave 2 data) factor analyses revealed a five-factor structure for the AERSQ: rumination/negative thinking, positive reorientation, communication, distraction, and cultural activities. We observed gender differences for most ER strategies in adolescence. We also evaluated the associations between the AERSQ subscales and mental health (self-harm; psychological difficulties including hyperactivity, conduct problems, emotional problems, and peer problems; prosocial behavior; depression; anxiety; stress; flourishing; and life satisfaction) across the three time points. Rumination/negative thinking had the strongest relationships with these mental health indicators, both cross-sectionally and longitudinally, in both genders. Distraction and cultural activities were less related to mental health, especially prospectively. Although the AERSQ showed good test-retest reliability and predictive validity over a 10-year period, the low internal consistency of two of its subscales (distraction and cultural activities) indicates that it may benefit from further development both in terms of the included items and psychometric testing.

Self-Evaluation Differences Among Swedish Children and Adolescents Over a 30-Year Period.

International research has found changes in how today's young people evaluate themselves. The present Swedish research contributes with new findings by distinguishing different patterns of change in self-evaluation in two age groups. The study investigates generational and gender differences in five self-evaluation dimensions in two samples, one from 1983 (N = 3052 10-16-year-old students) and one from 2013 (N = 1303 10-18-year-old students). Three age groups were analyzed. The generational comparison for primary school (ages 10-12) showed higher scores in 2013 than in 1983 for all five self-evaluation dimensions. Interactions between generation and gender were found for psychological well-being, relations to others, school competence evaluations, and the total score, demonstrating, in contrast to international research, a greater increase for girls than for boys. Noteworthy is that girls in primary school had higher scores in 2013. The generational comparison for lower secondary school (ages 13-15) demonstrated higher scores for school competence, relational self-evaluations, and a total higher score in 2013. Interactions between generation and gender were found for total, physical, and psychological well-being evaluation scores, indicating an increase for boys and a decrease for girls in 2013 compared to 1983. The gender comparison for secondary school (ages 16-18, 2013), showed gender differences for physical, psychological well-being, school competence evaluations, and for the total score to the advantage of boys. The study discusses changes in self-evaluation in relation to phenomena such as permissive child-rearing, decreased demands in school, increased self-enhancement behavior through social media, and narrow body ideals in today's society. The study recommends that interventions directed toward groups with low self-evaluation scores should be considered.

Family Connections in different settings and intensities for underserved and geographically isolated families: a non-randomised comparison study.

BACKGROUND: Family Connections (FC) is a multi-family skills training program for relatives of individuals with borderline personality disorder (BPD) and related difficulties, typically offered once per week for 12-14 weeks. Families with loved ones receiving residential Dialectical Behaviour Therapy DBT (DBT-R) in a different community, or those with multiple caregiving demands may have difficulty participating in weekly standard FC (FC-S). The aims of this paper are to: 1) Evaluate the results of the FC-S approach compared with an intensified weekend FC model developed for family members whose relatives are in DBT-R (FC-R); 2) Evaluate outcomes of FC-R for families with loved ones returning home from DBT-R, as little is known about how this population fares. METHODS: Data were collected at pre-treatment (T1), post-treatment (T2), and at six-to-seven-month follow-up (T3) in this non-randomized comparison study. A total of 82 family members participated, 34 of whom completed the FC-S program and 48 of whom completed the FC-R program. The evaluation was based upon outcomes derived from a standard battery used in FC research, analyzed by time and treatment setting. A composite score to evaluate family distress was generated. Two-way mixed multivariate analyses of variance (MANOVA) were employed to evaluate time (pre-versus-post versus follow-up) and group (FC-S versus FC-R). RESULTS: Scores on measures of mental health difficulties (General Severity Index), sense of burden (Burden Assessment Scale), and Global Family Functioning showed improvement over time. Having a loved one return home from DBT-R was associated with worsening on the GSI and the BAS at post-test. Notably, this deterioration was not found at follow-up. CONCLUSIONS: Little is known about families with loved ones receiving DBT-R other than the fact that their loved ones had not responded to previous services, which suggests greater complexity and chronicity. Because the family members receiving the weekend intensive FC-R version of FC demonstrated improvement, preliminary support exists for service providers to use the weekend intensive FC-R model as a time-and-cost efficient option whenever barriers exist to participating in weekly FC-S. Our findings also suggest that booster sessions may be indicated for families receiving loved ones home from DBT-R programs.