Personality trait risk factors for attempted suicide among young women with eating disorders.

OBJECTIVE: - Clinical observations and a review of the literature led us to hypothesize that certain personality and character traits could provide improved understanding, and thus improved prevention, of suicidal behaviour among young women with eating disorders. METHOD: - The clinical group consisted of 152 women aged between 18 and 24 years, with DSM-IV anorexia nervosa/restrictive type (AN-R = 66), anorexia nervosa/purging type (AN-P = 37), bulimia nervosa/non-purging type (BN-NP = 9), or bulimia nervosa/purging type (BN-P = 40). The control group consisted of 140 subjects. The assessment measures were the Minnesota Multiphasic Personality Inventory-second version (MMPI-2) scales and subscales, the Beck Depression Inventory (BDI) used to control for current depressive symptoms, plus a specific questionnaire concerning suicide attempts. RESULTS: - Suicide attempts were most frequent in subjects with purging behaviour (30.0% for BN-P and 29.7% for AN-P). Those attempting suicide among subjects with eating disorders were mostly students (67.8%). For women with AN-R the scales for 'Depression' and 'Antisocial practices' represented significant suicidal risk, for women with AN-P the scales for 'Hysteria', 'Psychopathic deviate', 'Shyness/Self-consciousness', 'Antisocial Practices', 'Obsessiveness' and 'Low self-esteem' were risk indicators and for women with BN-P the 'Psychasthenia', 'Anger' and 'Fears' scales were risk indicators. CONCLUSION: - This study provides interesting results concerning the personality traits of young women with both eating disorders and suicidal behaviour. Students and those with purging behaviour are most at risk. Young women should be given more attention with regard to the risk of suicide attempts if they: (a). have AN-R with a tendency to self-punishment and antisocial conduct, (b). have AN-P with multiple physical complaints, are not at ease in social situations and have antisocial behaviour, or (c). if they have BN-P and tend to be easily angered with obsessive behaviour and phobic worries. The MMPI-2 is an interesting assessment method for the study of traits indicating a risk of suicidal behaviour in young subjects, after controlling for current depressive pathology.

Evaluation of the Adolescent Drug Abuse Diagnosis instrument in a Swiss sample of drug abusers.

OBJECTIVE: The aim of this study was to evaluate a French language version of the Adolescent Drug Abuse Diagnosis (ADAD) instrument in a Swiss sample of adolescent illicit drug and/or alcohol users. PARTICIPANTS AND SETTING: The participants in the study were 102 French-speaking adolescents aged 13-19 years who fitted the criteria of illicit drug or alcohol use (at least one substance--except tobacco--once a week during the last 3 months). They were recruited in hospitals, institutions and leisure places. Procedure. The ADAD was administered individually by trained psychologists. It was integrated into a broader protocol including alcohol and drug abuse DSM-IV diagnoses, the BDI-13 (Beck Depression Inventory), life events and treatment trajectories. RESULTS: The ADAD appears to show good inter-rater reliability; the subscales showed good internal coherence and the correlations between the composite scores and the severity ratings were moderate to high. Finally, the results confirmed good concurrent validity for three out of eight ADAD dimensions. CONCLUSIONS: The French language version of the ADAD appears to be an adequate instrument for assessing drug use and associated problems in adolescents. Despite its complexity, the instrument has acceptable validity, reliability and usefulness criteria, enabling international and transcultural comparisons.

Self-esteem and mental health in early adolescence: development and gender differences

A longitudinal study of a general population (n=219; M age: 12, 13 and 14), was carried out between 1990 and 1993 over 3 years in Lausanne (Switzerland). Several questionnaires, validated in French, were used: Perceived Competence Scale, Social Support Appraisal and a questionnaire on mental health developed in our research Unit. We attempted to answer the following questions: Is there a global change in self-esteem during early adolescence? If so, does the way in which the young person perceives himself vary according to the social and relational environment? What are the differences between boys and girls in the development of self-esteem? What is the relation between self-esteem and mental health?As to the specific differences according to gender, results show that girls tend to have a poorer self-esteem than boys, whatever the domains taken into consideration. Differences are more significant with reference to appearance and athletic performance. As far as the development of self-esteem is concerned, there is no major change, notably when considering global perception. Results of a factor analysis underscore the fact that girls' self-esteem is more global and less differentiated by domain while boys separate the scholastic and behavioral part of their experience from the social. Global self-esteem has more influence on the level of depressive mood in girls than in boys.

[Assessment of the effects of age at start of puberty on mental health in pre-adolescence: results of a longitudinal study (1989-1991)]. / La mesure des effets du temps d'apparition de la puberté sur la santé psychique à la pré-adolescence: résultats d'une étude longitudinale (1989-1991).

The transition from childhood to adolescence is widely believed to be a stressful period in which the child faces multiple changes: physical changes, school choices, development of new social roles, and changes in the relation with his or her parents and friends. We investigated the effects of the timing of puberty on mental health, studied in a population of 219 young adolescents who were followed during three years (mean age at the beginning of the study was 12.5 years). The changes in the perception of the individual's body associated with puberty depended on the child's gender. Significant events during puberty had a negative effect on mental health. Although puberty remains a critical period of temporary unstable and fragile transition, most of the young adolescents coped relatively well with the physiological, psychological and social changes they faced.

From the child to the young adult: sex differences in the antecedents of psychological problems. A retrospective study over ten years.

Three hundred children chosen at random from the general population were examined at 9 years of age and seen again at 20. The results of the study emphasize the discontinuity of psychological problems between childhood and adulthood: serious difficulties in psychological functioning at age 9 do not predict disturbances at 20, but psychological disturbances at 20 may originate in adolescence. The overrepresentation, at age 9, of boys at risk disappears at 20, at which point there is a slightly higher proportion of women amongst the "cases". The factors which influence the mental health of girls and boys are analysed and discussed.

Mentally retarded adolescents: evaluation of communication strategies in different settings.

The present project aims to evaluate communication strategies used by mentally retarded adolescents in different types of verbal interaction. The study was carried out on 17 subjects and notably shows that their language content is mostly informative and that the control of conversation varies according to the interlocutor's status. Moreover, the global developmental age of the subjects appears to be a significant factor in the use of communication strategies. This could have pedagogical implications.

[Prognostic value of the neurodevelopmental status in the first year of life in children with increased perinatal risk]. / Valeur pronostique du status neuro-développemental durant la première année de vie chez les enfants à risque périnatal élevé.

Among 503 high-risk newborns followed-up systematically in a prospective study up to 5 years of age, abnormalities of the development of posture, of maturation of tone and of psychomotor development were diagnosed at the age of 6 months in 70 children (13.9%) who form the study group. Among the other 433 high-risk newborns who presented a normal psychomotor development at the age of 6 months, 73 were selected at random and form the control group. In the study group, 59% of the children had a development which became normal during the second year of life (transitory disorders), 21% had persistent minor neurological abnormalities at the age of 5 years, and 20% evolved towards cerebral palsy and/or mental retardation. In the control group, 97.3% of the children remained normal and 2.7% presented minor neurological abnormalities at 5 years. Three parameters are important to estimate the prognosis of the children in the study group. These are: the presence of neurological disorders during the neonatal period, the type of neurodevelopmental abnormalities diagnosed at the age of 6 months, and the evolution of these abnormalities during the second semester of life. Among the 14 major handicaps, 13 were found in children who presented neurological neonatal disorders and 12 appeared in children who had an abnormality of muscular tonus associated with cognitive and social retardation at the age of 6 months. 52% of the children, whose status had not been "normalized" at 12 months, had a major handicap at 5 years. However, a hypertonia predominating in the lower limbs and observed at 6 months has a good prognosis; it disappears during the second year of life in 81.2% of cases (transitory disorders) and is associated with persistent minor neurological abnormalities in 18.8% of cases.--This study gives useful information for the establishment of an early prognosis and a rational management of the high-risk newborn children who present neurodevelopmental abnormalities during their first year of life.

High risk appropriate for gestational age (AGA) and small for gestational age (SGA) preterm infants. Neurological handicap and developmental abnormalities at five years of age.

Outcome at five years of age of 110 high risk AGA, 71 high risk SGA preterm infants with similar birth weight and 102 term control infants was studied. Mean IQ in the 3 groups was not statistically different. Major handicaps were found in 16.3% of the AGA and in 8.5% of the SGA preterms. There was no major handicap among the controls. Minor neurodevelopmental abnormalities were present in 25.6% of AGA, 28.2% of SGA and 19.6% of controls. The types of neurodevelopmental handicaps were different in the 3 groups and generally more severe in the AGA group. All the major handicaps among AGA preterms were found in children with severe neonatal complications. In the SGA preterm group, only 1/3 of the major handicaps can be related to perinatal complications. Affective and behavior disorders were probably related in some way to neurodevelopmental achievement. This study showed that preterm infants with GA less than or equal to 32 weeks are more at risk than more mature SGA preterms with similar birth weight.

[Disorders of the mother-child relationship in newborn infants with low birth weight]. / Troubles de la relation mère-enfant chez les nouveau-nés de petits poids de naissance.

The influence of premature birth or intrauterine growth retardation (IUGR) on the mother-child relationship has been studied in 80 children with birth-weight below 2000 g, treated in the Neonatology Unit of the Pediatric Department of Lausanne University. 40 children with birth-weight over 2500 g and without perinatal complications born in the Obstetrical Department of the same hospital were used as controls. The 80 infants with low birth-weight presented only minor neonatal disturbances and showed later on a normal psychomotor development. The mother-child relationship was evaluated by free and structured interviews accompanied by a questionnaire and by regular contacts throughout the first 12 months. With the exception of the professional work of the mother during and after pregnancy, all the family and social factors were not significantly different in the 3 groups. The mothers of premature children showed significantly more disturbances of their family relationship than the mothers in the control group. On the other hand, a significantly higher number of attachment problems is the only difference observed in the group of mothers of IUGR-babies. There was no mathematical correlation between these problems and the characteristics of the family and social-economic environment of the mothers. The importance of subjective, i.e. psychological, factors as cause of difficulties in the mother-child relationship is stressed.