Adolescent self-harm in Ghana: a qualitative interview-based study of first-hand accounts

Background: Recent prevalence studies suggest that self-harm among adolescents in sub-Saharan Africa is as common as it is in high income countries. However, very few qualitative studies exploring first-person accounts of adolescent self-harm are available from sub-Saharan Africa. We sought to explore the experiences and first-person perspectives of Ghanaian adolescents reporting self-harm - for deeper reflections on the interpretive repertoires available in their cultural context for making sense of self-harm in adolescents. Methods: Guided by a semi-structured interview protocol, we interviewed one-to-one 36 adolescents (24 in-school adolescents and 12 street-connected adolescents) on their experiences of self-harm. We applied experiential thematic analysis to the data. Results: Adolescents’ description of the background to their self-harm identified powerlessness in the family context and unwanted adultification in the family as key factors leading up to self-harm among both in-school and street-connected adolescents. Adolescents’ explanatory accounts identified the contradictory role of adultification as a protective factor against self-harm among street-connected adolescents. Self-harm among in-school adolescents was identified as a means of “enactment of tabooed emotions and contestations”, as a “selfish act and social injury”, as “religious transgression”, while it was also seen as improving social relations. Conclusions: The first-person accounts of adolescents in this study implicate familial relational problems and interpersonal difficulties as proximally leading to self-harm in adolescents. Self-harm in adolescents is interpreted as an understandable response, and as a strong communicative signal in response to powerlessness and family relationship difficulties. These findings need to be taken into consideration in the planning of services in Ghana and are likely to be generalisable to many other countries in sub-Saharan Africa

Comment améliorer l’adhésion aux soins des adolescents suicidants après une prise en charge aux urgences : une revue de la littérature

International audienceOBJECTIVES:Suicidal adolescents admitted in an Emergency Department (ED) present a high risk of suicidal reattempts. Poor observance of follow-up in this particular group imped the efficacity of the treatment. We propose to summarize the international literature on ED interventions promoting suicidal adolescents' adherence to care. METHOD:We carried out a comprehensive review of papers listed in PubMed, PsycInfo, and CINHAL databases using keywords about adolescence, suicide, and ED. We also manually consulted the main journals specialized in suicidology (Crisis and Suicide and Life-Threatening Behavior) and adolescence (Journal of the American Academy of Child and Adolescent Psychiatry, Journal of Adolescent Health, Neuropsychiatrie de l'Enfance et de l'Adolescence). We selected the relevant articles describing or evaluating one or more interventions initiated in the ED and designed to promote adolescent adherence to post-emergency care. The results are presented in a narrative review form. RESULTS:Interventions are organized in three groups: interventions that take place solely at the ED (problem-solving interventions and educational interventions directed to families) and interventions that take place during and after emergency care (we included in this group the ED-Care program, the FISP program, and the SAFETY program), to which should be added interventions that take place prior to care, in particular specific trainings for medical and paramedical teams. Small samples and barriers in measuring adherence to care make statistical comparisons difficult, yet the interventions that seem most effective are those that target the time both during and after ED discharge, those which are implemented most rapidly after discharge, those which actively include parents, and those which involve an implication of the families about barriers to follow-up. CONCLUSION:Our results show an effectiveness of complete programs on short-term compliance but no conclusion can be drawn on long-term effects. Most comprehensive care programs are based on the principle of adolescent compliance, which remains problematic. Until today, no ideal protocol exists to improve short-term as well as long-term compliance to care among adolescents after a suicide attempt. We have to improve our understanding of facilitators and barriers to follow-up using quantitative as well as qualitative research studies. Although it is well established that parents' involvement in the early stages of care is essential, little is known about the underlying processes. In these situations, qualitative studies could help to better target interventions that lead more particularly to follow up compliance in adolescence

Ettan, le petit accordeur des filiations. OU la nécessité de penser l'altérité en consultation d'adoption internationale

International audience[No abstract

Relations parents-adolescents autour des automutilations : une étude qualitative

International audienceObjectivesNon-suicidal self-injury (NSSI) is a frequent issue during adolescence responsible for many difficulties in the relationship between parents and adolescents. This study explores the function of self-harm in parent-adolescent relationships.MethodsThis is a qualitative study based on semi-structured interviews with adolescents, who are receiving psychiatric care for DSH (deliberate self harm), and their parents. Data are analysed using the Interpretative Phenomenological Analysis.ResultsTwenty-five interviews were carried out with 11 adolescents and 14 parents. Ten themes were organized around three super-ordinate themes. The relationship difficulties between parents and adolescents are marked by the lack of communication, fragile links and great difficulty to trust one another. The discovery of DSH behaviour by the parents triggers an emotional turmoil described as an extremely violent experience associated with very painful feelings. Finally, parents describe a change in the family dynamics induced by DSH. These changes are perceptible through a movement of independence and regaining of the control from the adolescent, and a wish for mutual protection of adolescents and their parents. Including parents more in the therapeutic care, both as an impacted person and at the same time as a co therapist, appears to be indispensable.Buts de l’étudeLes automutilations sont fréquentes à l’adolescence et génèrent de nombreuses difficultés relationnelles entre parents et adolescents. Nous proposons dans cette étude d’explorer la fonction des automutilations au cœur de la relation parent-adolescent.Patient et méthodeIl s’agit d’une étude qualitative basée sur des entretiens semi-structurés auprès d’adolescents suivis en pédopsychiatrie pour des automutilations et de leurs parents analysés avec la méthode Interpretative Phenomenological Analysis.RésultatsVingt cinq entretiens ont été recueillis (11 adolescents, 14 parents). Ils ont permis de dégager 10 thèmes que nous avons classés en trois méta-thèmes : les difficultés relationnelles entre parents et adolescents, le bouleversement émotionnel induit par la découverte des automutilations, et les réorganisations relationnelles secondaires à la découverte des automutilations.ConclusionsLa dynamique familiale est largement modifiée par la découverte des automutilations. La souffrance des parents, leur incompréhension, et leur demande d’aide est importante à entendre dans le soin. Les automutilations mettent en évidence des liens familiaux fragiles, et les parents souvent désemparés essaient de reprendre le contrôle de la situation par des réactions qui semblent parfois aggraver la souffrance des adolescents. Inclure les parents davantage dans la prise en charge thérapeutique, à la fois en tant que personne impactée et en même temps en tant que co thérapeute apparaît indispensable