[Violence and aggression in adolescents and young adults. Review of the recent literature]. / Violence et agressivité chez les adolescents et les jeunes adultes. Revue critique de la littérature récente.

A highly topical subject, violence, its consequences as well as its causes, deserve more attention on behalf of the public health authorities. On one hand, nowadays, the concepts in this field tend to become more global than before; however, on the other hand the epidemiological, etiological and therapeutic approaches benefit also from considering more limited behavior categories and age groups. In this review of the international literature, the authors focus their attention on intentional (excluding accidents) and interpersonal (excluding self-destructive behavior) violence. They consider by priority adolescents (10 to 19) and young adults (15 to 24). After a general introduction to the theme and the presentation of the relevant concepts and definitions, the authors, as a complement to their earlier publication on violence, develop epidemiological aspects concerning mortality, morbidity and the sources of information about these two topics. Their view is partly a critical one, including considerations on risk factors and risk predictors. The etiological aspects are developed along three axes : biomedical components, mainly of neuro-psychiatric and neurological nature ; family violence ; the broader social environment. The following part is devoted to care and prevention. In the discussion, several of the main issues considered in the conceptual, epidemiological, etiological as well as curative and preventive approaches are brought up again, with a perspective on presenting new proposals for further consideration and developments as well as on broadening the initial debate of the introduction.

Intentional violence among adolescents and young adults: an epidemiological perspective.

Intentional violence consists mainly of non-accidental interpersonal violence and suicidal behaviour; the remaining categories are other violence and/or violence with undeterminted intention [corrected]. In almost all the countries considered in this study, intentional violence is taking on worrying proportions in adolescence (10-19-year-olds) and is on the increase among young adults (15-24-year-olds). The scale of the problem is relatively well known thanks to national mortality rates. The relative proportions of murders and suicides vary considerably from one country to another, though they remain fairly constant over time, whether the diachronic progression of mortality due to intentional violence increases, remains stable or falls in the country concerned; this is true for both sexes and for both the age groups considered (15-19 and 20-24). Nevertheless, in view of the much higher incidence of intentionally violent behaviour that does not result in death, more resources should be allocated to epidemiological studies in that area, especially in terms of quantitative and qualitative methods, where possible in association with interdisciplinary projects. Only with a better knowledge of the risk factors and if possible identification of the predictive factors (in the probabilistic sense of the term) could we devise, conduct and evaluate preventive measures that are better targeted than those used so far, whether the factors are socio-cultural, socioeconomic or psychosocial. This is the justification, especially the ethical justification, of further epidemiological studies of an analytical or even interventional nature, going beyond the descriptive studies that have been made by most researchers to date.

Longitudinal studies: social and psychological factors.

In spite of the great variety of longitudinal studies, one may consider two main orientations: on one hand the "comprehensive" studies, based on the combined or parallel observation of numerous psychosocial characteristics collected at successive stages of the child's development; on the other hand, studies focussed on limited topics based on the observation and longitudinal analysis of a restricted number of specific characteristics. Some examples of these different approaches are presented. The chapter considers, finally, several methodological issues, including new developments as well as constraints and problems. Recent methodological developments concern, i.a., videoscopic recording techniques which may be applied to the behaviour of mother and child (etc...) whether in the laboratory or in normal life-situations. Moreover, in view of the statistical analysis of the datas appropriate instruments are developed which at the same time keep the nuances and details of the clinical observation. Finally, some examples of problems linked to the attrition-rate of the observed sample are presented, as well as specific ethical issues raised by longitudinal studies.

[Depressive symptoms in adolescents (1). Prevalence - remedy]. / Symptomes dépressifs chez l'adolescent (1). Prévalence - recours.

This study concerns a population of 900 Belgian adolescents aged 16 to 21, i.e. 300 students, 300 workers and 300 unemployed. They accepted to answer a detailed questionnaire including a French version of the CES-D scale (Center for Epidemiological Studies-Depression). The prevalence rates of depressive symptoms observed in Belgium are higher than those found in the US. Moreover the Belgian adolescents observed in this study reach more often than U.S. adolescents the level of "clinical depressions" (18.9%). The rates are still higher when "occasional depressive symptoms" are also considered (occurrence: 1-2 days during the last week). However comparisons of this kind cannot be interpreted in a simplistic way. The rates vary with the social status of the adolescents: the unemployed present the highest level, followed by students; the workers have, comparatively, the lowest rates. These high prevalence rates require in depth analyses. The adolescents may need medical, psychological or social assistance which should be offered, at the primary care level. However their own choice leads them to get help elsewhere: close friends, partners (couple), simple friends (in French: "copain" and "copine"), siblings etc. Adolescents consult their doctor only exceptionally. This raises important questions, namely in the field of the training of health personnel.