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.

[The adolescent with a chronic somatic disorder]. / L'adolescent atteint d'une affection somatique chronique.

Adolescence, a period of psychic reorganization which allows for new adjustments in order to face future life and reorganize the experience of the past, is one of the critical phases of existence. It is described as a "new birth", a successful achievement of individuation and separation processes. For the adolescent with an infirmity or chronic illness, and for his family, there exist specific problems in addition to those encountered by a healthy adolescent. The painful realization of social, professional and relational barriers is reactivated. The feeling of failure and helplessness, the impairment of self-esteem, and anger at being the victim of the unfairness of destiny, represent a supplementary affective burden for the adolescent and his family. This results in a risk of deterioration, either towards affective and social withdrawal expressed by overadaptation and weakening of psychic functions, or towards autoaggressive acting-out or various forms of marginalization. Preventive and therapeutic action by the individual and the family are discussed in the light of the case history of an adolescent suffering from a facial malformation.

Psychotherapeutic training in an institutional setting.

Many child and adolescent psychotherapists are asked to work in specialized institutions (where the children are either interns or externs), with children presenting behaviour problems, learning difficulties, mental handicap or important psychosocial problems. They learn through diverse treatment forms, or parent accompaniment during the child's treatment (bifocal or conjoint treatment more or less regular therapeutic sessions with both parents and children, etc.). The treatment of children within an institution makes the treatment modalities and technique more complicated. The psychotherapist must have a perfect knowledge of the specific environment of the child, and keep in mind the desires and requests of the direction and the people who work directly with the child (teachers, specialized teachers, etc.). How can the problems brought up by the rivalry between the institution and the psychotherapist be canalized: length of therapy, merits (how did the pedagogical intervention help, recognition of a specific action or of work done in conjunction with the educative action)? If these facts are not recognized, the treatment will often be interrupted and the psychotherapist may be excluded from the institution. This will be avoided by ensuring further training of the therapist.

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.

The validity of the French version of the GHQ-28 and PSYDIS in a community sample of 20 year olds in Switzerland.

The 28-item GHQ (General Health Questionnaire) and the 43-item PSYDIS (Psychic Distress) were translated into French and administered to a community sample of 233 young adults. Of the two tests, the GHQ was shown to have the better correlation with the clinical assessment. For PSYDIS, specificity was 72.8, sensitivity was 64.2, but the misclassification rate rose to 29.2. The GHQ misclassified 18.5% of the respondents at the best cut-off point (5/6), with a specificity of 91.1 and a sensitivity of 49.1. The corrections C-GHQ (Goodchild and Duncan-Jones method of scoring) and simple Likert scoring improved sensitivity, although this was still unsatisfactory with males. Considering the lability of troubles in a young population, the GHQ should be applied with caution for epidemiological purposes.

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.

[Epilepsy from the pediatric and adolescent psychiatric viewpoint]. / Epilepsie aus kinder- und jugendpsychiatrischer Sicht.

For epileptic children and their families, the development during the past two decades of drug treatment and social, educational and professional integration as well as psychological support has led to better help and comprehension. The traditional psychiatric concepts of an epileptic constitution or of a specific epileptic psychopathology in childhood and adolescence are nowadays subject of doubt. The idea of a linear relationship between organic and mental disease, postulating that symptoms are direct consequences of a brain dysfunction or lesion had to be abandoned. The physician has to deal with symptoms not only as organic dysfunctions but also as senseful in a psychodynamic context. Modern concepts are based on the idea of a structurally and functionally integrated psychophysical level of maturity, taking account of the individual psyche as well as of family and social relationships. This model allows to prevent social atrophy and to better understand and use the insufficiently exploited evolutionary potential in therapy and educational measures. Epileptic seizures are a particular and manifold charge for the child, not only on the social level, but very deeply in his inner life.

[Description of a population of children and adolescents with mental handicaps]. / Description d'une population d'enfants et d'adolescents handicapés mentaux.

65 mentally handicapped children and adolescents, examined at the Mental Deficiency Consultation of the Child and Adolescent Psychiatry Service of the Lausanne University, are described, using the axis of organic factors, psychiatric factors and degree of intellectual retardation. The necessity of a multiaxial diagnosis classification is discussed and its usefulness for clinical work and international epidemiological researches is emphasised.