Groot risico op zelfdoding bij zelfverwondende vluchtelingen
Minderjarige vluchtelingen die zichzelf verwonden lopen een groot risico op zelfmoord. Tot die conclusie komt onderzoekster Sarah Verroken (VUB) in haar masterproef. Heel wat jonge vluchtelingen voelen zich sociaal geïsoleerd. Bovendien hebben ze vaak het gevoel anderen alleen maar tot last te zijn. Een uiterst gevaarlijke cocktail, zeker voor die minderjarige vluchtelingen die zichzelf al meermaals verwondingen hebben toegebracht. Volgens Verroken moeten hulpverleners afstappen van de clichés en luisteren naar de noden van elke minderjarige vluchteling.
Volgens heel wat psychologen kan zelfverwonding leiden tot zelfmoord. Twee factoren spelen daarbij een cruciale rol: sociale isolatie en het gevoel anderen tot last te zijn. Net deze twee factoren zijn volgens Verroken in hoge mate aanwezig bij vluchtelingenjongeren die zichzelf ooit verwond hebben. “Het maakt ze dus uitermate kwetsbaar voor zelfmoord. 68% geeft bovendien aan zichzelf zes of meer keer verwond te hebben. Ter vergelijking, bij de Westerse jeugd is dat ongeveer 25%. Zelfverwonding bij jonge vluchtelingen als een roep om aandacht afdoen, is dus klinkklare onzin. Integendeel, het is een uiterst ernstig alarmsignaal: de gevluchte jongere is, letterlijk, in levensgevaar.”
Mentale veerkracht…
In januari 2017 telde België 7.704 minderjarige vluchtelingen, waarvan 2.057 zonder begeleiding het land binnenkwamen. Stuk voor stuk kinderen die hals over kop afscheid namen van lief en leed. Onderweg geconfronteerd werden met geweld en onveiligheid. Hun vrienden of familieleden vermoord zagen. En door mensensmokkelaars koudweg gedropt werden in een land waar ze de taal en cultuur niet begrijpen.
Verroken: “Maar de veerkracht van de jongeren die in ons land terechtkomen, is ongelooflijk. Enkel de sterksten en meest veerkrachtigen onder hen lukken in hun tocht en bereiken veiliger oorden. Dat deze jongeren na zo een waanzinnige reis in hun opzet geslaagd zijn Europa te bereiken, kan bovendien positieve effecten hebben op hun mentale gezondheid. Wat natuurlijk helpt om hier in België de draad terug op te pikken.”
Dat verklaart wellicht dat ‘slechts’ evenveel minderjarige vluchtelingen als Westerse minderjarigen aangeeft zichzelf ooit opzettelijk verwond te hebben: ongeveer één op vijf.
…maar een broos evenwicht
Heel wat minderjarige vluchtelingen verwonden zichzelf. Zowel jongens als meisjes op de vlucht, krassen zichzelf of slaan of bonken uit frustratie op allerlei voorwerpen. De handen, polsen of armen moeten er het vaakst aan geloven. Op zich is dat vergelijkbaar met hun Westerse leeftijdsgenoten. Maar samen met de hierboven benoemde factoren, sociale isolatie en het gevoel anderen tot last te zijn, is het een dodelijke combinatie. “De minderjarige vluchtelingen in België zijn een sterke groep, maar zij die het moeilijk hebben zijn niet in vakjes onder te verdelen,” waarschuwt Verroken. “Ze lopen een hoog risico tot zwaardere mentale problemen en zelfs zelfdoding. Een onveilig verleden, verwarrend heden en een onzekere toekomst voorspellen dus niet per se mentale problemen, maar de ernst van die problemen wordt wel groter.”
Luisteren naar elk individu
Maar waarom verwonden de jongeren zich dan precies? “72% van de vluchtelingenjeugd doet het om zelfmoord te oefenen. Bij 67% hielp het om met ongemakkelijke gevoelens om te gaan. Andere redenen waren omgaan met stress, druk, frustratie of woede en zichzelf helpen huilen,” zegt Verroken. Ook dat verschilt weinig van de Westerse jeugd. “Maar net zoals bij een Westerse jongere, hebben elk van deze jongens en meisjes op de vlucht, behoefte aan een luisterend oor. Van iemand die hen uit hun isolement haalt. Van iemand die hen het gevoel geeft dat ze iets waard zijn. Hulpverleners moeten dus afstappen van de clichés, en elke individuele jongere de aandacht geven die hij of zij verdient.”
Voor meer info over zelfverwonding en hoe te reageren, surf naar www.zelfverwonding.be. Voor vragen over zelfmoord, bel 1813 of surf naar www.zelfmoord1813.be.
Bibliografie
ADDIN ZOTERO_BIBL {"custom":[]} CSL_BIBLIOGRAPHY Adrian, M., Zeman, J., Erdley, C., Lisa, L., & Sim, L. (2011). Emotional Dysregulation and Interpersonal Difficulties as Risk Factors for Nonsuicidal Self-Injury in Adolescent Girls. Journal of Abnormal Child Psychology, 39(3), 389–400. https://doi.org/10.1007/s10802-010-9465-3
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM 5. Washington (D.C.): American Psychiatric Publishing.
Baetens, I. (2013). Non-suicidal self-injury in adolescence: Interplay between psychological distress and parenting. Katholieke Universiteit Leuven, Leuven. Retrieved from https://lirias.kuleuven.be/bitstream/123456789/413095/1/PhD_BaetensImke…
Baetens, I., & Claes, L. (2014). Screeningsvragenlijst opzettelijk zelfverwondend gedrag.
Baetens, I., & Claes, L. (n.d.). De verkorte opzettelijk zelfverwondend gedrag vragenlijst (v-ZVGV).
Baetens, I., Claes, L., Muehlenkamp, J., Grietens, H., & Onghena, P. (2012). Differences in psychological symptoms and self-competencies in non-suicidal self-injurious Flemish adolescents. Journal of Adolescence, 35(3), 753–759. https://doi.org/10.1016/j.adolescence.2011.11.001
Baetens, I., Claes, L., Willem, L., Muehlenkamp, J., & Bijttebier, P. (2011). The relationship between non-suicidal self-injury and temperament in male and female adolescents based on child- and parent-report. Personality and Individual Differences, 50(4), 527–530. https://doi.org/10.1016/j.paid.2010.11.015
Bean, T. M., Eurelings-Bontekoe, E., & Spinhoven, P. (2007). Course and predictors of mental health of unaccompanied refugee minors in the Netherlands: One year follow-up. Social Science & Medicine, 64(6), 1204–1215. https://doi.org/10.1016/j.socscimed.2006.11.010
Betancourt, T. S., Newnham, E. A., Layne, C. M., Kim, S., Steinberg, A. M., Ellis, H., & Birman, D. (2012). Trauma History and Psychopathology in War-Affected Refugee Children Referred for Trauma-Related Mental Health Services in the United States. Journal of Traumatic Stress, 25(6), 682–690. https://doi.org/10.1002/jts.21749
Bhui, K., Audini, B., Singh, S., Duffett, R., & Bhugra, D. (2006). Representation of asylum seekers and refugees among psychiatric inpatients in London. Psychiatric Services, 57(2), 270–272. https://doi.org/10.1176/appi.ps.57.2.270
Bhui, K., McKenzie, K., & Rasul, F. (2007). Rates, risk factors & methods of self harm among minority ethnic groups in the UK: a systematic review. BMC Public Health, 7(1). https://doi.org/10.1186/1471-2458-7-336
Bronstein, I., Montgomery, P., & Dobrowolski, S. (2012). PTSD in Asylum-Seeking Male Adolescents From Afghanistan. Journal of Traumatic Stress, 25(5), 551–557. https://doi.org/10.1002/jts.21740
Brunner, R., Kaess, M., Parzer, P., Fischer, G., Carli, V., Hoven, C. W., … Wasserman, D. (2014). Life-time prevalence and psychosocial correlates of adolescent direct self-injurious behavior: A comparative study of findings in 11 European countries. Journal of Child Psychology and Psychiatry, 55(4), 337–348. https://doi.org/10.1111/jcpp.12166
Brunner, R., Parzer, P., Haffner, J., Steen, R., Roos, J., Klett, M., & Resch, F. (2007). Prevalence and psychological correlates of occasional and repetitive deliberate self-harm in adolescents. Archives of Pediatrics & Adolescent Medicine, 161(7), 641–649. https://doi.org/10.1001/archpedi.161.7.641
Buser, J. K., Buser, T. J., & Rutt, C. C. (2017). Nonsuicidal Self-Injury and Spiritual/Religious Coping. Journal of Mental Health Counseling, 39(2), 132–148. https://doi.org/10.17744/mehc.39.2.04
Claes, L., Luyckx, K., Baetens, I., Van de Ven, M., & Witteman, C. (2015). Bullying and Victimization, Depressive Mood, and Non-Suicidal Self-Injury in Adolescents: The Moderating Role of Parental Support. Journal of Child and Family Studies, 24(11), 3363–3371. https://doi.org/10.1007/s10826-015-0138-2
Claes, L., & Vandereycken, W. (2007). Self-injurious behavior: differential diagnosis and functional differentiation. Comprehensive Psychiatry, 48(2), 137–144. https://doi.org/10.1016/j.comppsych.2006.10.009
Derluyn, I. (2004). Emotional and behavioural problems in minor migrants in Belgium. Ethnicity & Health, 9, S34–S35.
Derluyn, I., Broekaert, E., & Schuyten, G. (2008). Emotional and behavioural problems in migrant adolescents in Belgium. European Child & Adolescent Psychiatry, 17(1), 54–62. https://doi.org/10.1007/s00787-007-0636-x
Derluyn, I., Mels, C., & Broekaert, E. (2009). Mental Health Problems in Separated Refugee Adolescents. Journal of Adolescent Health, 44(3), 291–297. https://doi.org/10.1016/j.jadohealth.2008.07.016
Diclemente, R., Ponton, L., & Hartley, D. (1991). Prevalence and Correlates of Cutting Behavior - Risk for Hiv Transmission. Journal of the American Academy of Child and Adolescent Psychiatry, 30(5), 735–739. https://doi.org/10.1016/S0890-8567(10)80007-3
Fazel, M., & Stein, A. (2002). The mental health of refugee children. Archives of Disease in Childhood, 87(5), 366–370. https://doi.org/10.1136/adc.87.5.366
Fedasil. (2017). Fedasil Maandrapport Januari 2017. Fedasil. Retrieved from http://fedasil.be/sites/5042.fedimbo.belgium.be/files/fedasil_maandrapp…
Federale Overheidsdienst Binnenlandse Zaken. (n.d.). Niet Begeleide Minderjarige Vreemdeling. Retrieved 19 March 2017, from https://dofi.ibz.be/sites/dvzoe/NL/Gidsvandeprocedures/Pages/NietBegele…
Gandhi, A., Claes, L., Bosmans, G., Baetens, I., Wilderjans, T. F., Maitra, S., … Luyckx, K. (2016). Non-Suicidal Self-Injury and Adolescents Attachment with Peers and Mother: The Mediating Role of Identity Synthesis and Confusion. Journal of Child and Family Studies, 25(6), 1735–1745. https://doi.org/10.1007/s10826-015-0350-0
Garisch, J. A., & Wilson, M. S. (2015). Prevalence, correlates, and prospective predictors of non-suicidal self-injury among New Zealand adolescents: cross-sectional and longitudinal survey data. Child and Adolescent Psychiatry and Mental Health, 9(1), 28. https://doi.org/10.1186/s13034-015-0055-6
Gholamrezaei, M., De Stefano, J., & Heath, N. L. (2015). Nonsuicidal self-injury across cultures and ethnic and racial minorities: A review. International Journal of Psychology: Journal International De Psychologie. https://doi.org/10.1002/ijop.12230
Goodman, A., Heiervang, E., Fleitlich-Bilyk, B., Alyahri, A., Patel, V., Mullick, M. S. I., … Goodman, R. (2012). Cross-national differences in questionnaires do not necessarily reflect comparable differences in disorder prevalence. Social Psychiatry and Psychiatric Epidemiology, 47(8), 1321–1331. https://doi.org/10.1007/s00127-011-0440-2
Goodman, R. (1997). The strengths and difficulties questionnaire: A research note. Journal of Child Psychology and Psychiatry and Allied Disciplines, 38(5), 581–586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x
Hamza, C. A., Stewart, S. L., & Willoughby, T. (2012). Examining the link between nonsuicidal self-injury and suicidal behavior: A review of the literature and an integrated model. Clinical Psychology Review, 32(6), 482–495. https://doi.org/10.1016/j.cpr.2012.05.003
Hawton, K., Rodham, K., Evans, E., & Weatherall, R. (2002). Deliberate self harm in adolescents: self report survey in schools in England. BMJ (Clinical Research Ed.), 325(7374), 1207–1211.
Hilt, L. M., Nock, M. K., Lloyd-Richardson, E. E., & Prinstein, M. J. (2008). Longitudinal study of nonsuicidal self-injury among young adolescents - Rates, correlates, and preliminary test of an interpersonal model. Journal of Early Adolescence, 28(3), 455–469. https://doi.org/10.1177/0272431608316604
Jacobson, C. M., & Gould, M. (2007). The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: a critical review of the literature. Archives of Suicide Research: Official Journal of the International Academy for Suicide Research, 11(2), 129–147. https://doi.org/10.1080/13811110701247602
Jarvi, S., Jackson, B., Swenson, L., & Crawford, H. (2013). The Impact of Social Contagion on Non-Suicidal Self-Injury: A Review of the Literature. Archives of Suicide Research, 17(1), 1–19. https://doi.org/10.1080/13811118.2013.748404
Jensen, T. K., Skardalsmo, E. M. B., & Fjermestad, K. W. (2014). Development of mental health problems - a follow-up study of unaccompanied refugee minors. Child and Adolescent Psychiatry and Mental Health, 8, 29. https://doi.org/10.1186/1753-2000-8-29
Kaess, M., Parzer, P., Mattern, M., Plener, P. L., Bifulco, A., Resch, F., & Brunner, R. (2013). Adverse childhood experiences and their impact on frequency, severity, and the individual function of nonsuicidal self-injury in youth. Psychiatry Research, 206(2–3), 265–272. https://doi.org/10.1016/j.psychres.2012.10.012
Kiekens, G., Bruffaerts, R., Nock, M. K., Van de Ven, M., Witteman, C., Mortier, P., … Claes, L. (2015). Non-suicidal self-injury among Dutch and Belgian adolescents: Personality, stress and coping. European Psychiatry: The Journal of the Association of European Psychiatrists, 30(6), 743–749. https://doi.org/10.1016/j.eurpsy.2015.06.007
Kirtley, O. J., O’Carroll, R. E., & O’Connor, R. C. (2016). Pain and self-harm: A systematic review. Journal of Affective Disorders, 203, 347–363. https://doi.org/10.1016/j.jad.2016.05.068
Klonsky, E. D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27(2), 226–239. https://doi.org/10.1016/j.cpr.2006.08.002
Klonsky, E. D., & Olino, T. M. (2008). Identifying clinically distinct subgroups of self-injurers among young adults: A latent class analysis. Journal of Consulting and Clinical Psychology, 76(1), 22–27. https://doi.org/10.1037/0022-006X.76.1.22
Kress, V. E., Newgent, R. A., Whitlock, J. L., & Mease, L. (2015). Spirituality/Religiosity, Life Satisfaction, and Life Meaning as Protective Factors for Nonsuicidal Self-Injury in College Students. Journal of College Counseling, 18(2), 160–174. https://doi.org/10.1002/jocc.12012
Liu, X., Chen, H., Bo, Q.-G., Fan, F., & Jia, C.-X. (2017). Poor sleep quality and nightmares are associated with non-suicidal self-injury in adolescents. European Child & Adolescent Psychiatry, 26(3), 271–279. https://doi.org/10.1007/s00787-016-0885-7
Martin, G., Swannell, S. V., Hazell, P. L., Harrison, J. E., & Taylor, A. W. (2010). Self-injury in Australia: a community survey. Medical Journal of Australia, 193(9), 506–510.
Mental Health National Outcomes and Casemix Collection: Overview of clinician-rated and consumer self-report measures. Version 1.50. (2003). Department of Health and Ageing, Canberra. Retrieved from http://www.amhocn.org/sites/default/files/publication_files/mhnocc_over…
Muehlenkamp, J. J., Claes, L., Havertape, L., & Plener, P. L. (2012). International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child and Adolescent Psychiatry and Mental Health, 6, 10. https://doi.org/10.1186/1753-2000-6-10
Muehlenkamp, J. J., Kerr, P. L., Bradley, A. R., & Larsen, M. A. (2010). Abuse Subtypes and Nonsuicidal Self-Injury Preliminary Evidence of Complex Emotion Regulation Patterns. Journal of Nervous and Mental Disease, 198(4), 258–263. https://doi.org/10.1097/NMD.0b013e3181d612ab
Muris, P., Meesters, C., & van den Berg, F. (2003). The Strengths and Difficulties Questionnaire (SDQ) - Further evidence for its reliability and validity in a community sample of Dutch children and adolescents. European Child & Adolescent Psychiatry, 12(1), 1–8. https://doi.org/10.1007/s00787-003-0298-2
Ndengeyingoma, A., de Montigny, F., & Miron, J.-M. (2014). Development of personal identity among refugee adolescents: Facilitating elements and obstacles. Journal of Child Health Care, 18(4), 369–377. https://doi.org/10.1177/1367493513496670
Nixon, M. K., Cloutier, P., & Jansson, S. M. (2008). Nonsuicidal self-harm in youth: a population-based survey. CMAJ: Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 178(3), 306–312. https://doi.org/10.1503/cmaj.061693
Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C., & Lee, S. (2008). Suicide and Suicidal Behavior. Epidemiologic Reviews, 30(1), 133–154. https://doi.org/10.1093/epirev/mxn002
Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72(5), 885–890. https://doi.org/10.1037/0022-006X.72.5.885
Patel, N., & Hodes, M. (2006). Violent deliberate self-harm amongst adolescent refugees. European Child & Adolescent Psychiatry, 15(6), 367–370. https://doi.org/10.1007/s00787-006-0543-6
Procter, N. (2005). Emergency mental health nursing for self-harming refugees and asylum seekers. International Journal of Mental Health Nursing, 14(3), 196–201. https://doi.org/10.1111/j.1440-0979.2005.00381.x
Procter, N., Williamson, P., Gordon, A., & McDonoughs, D. (2011). Refugee and Asylum Seeker Self Harm with Implications for Transition to Employment Participation -A Review Introduction (PDF Download Available). Suicidologi, 16(3). Retrieved from https://www.researchgate.net/publication/259742656_Refugee_and_Asylum_S…
Ramel, B., Taljemark, J., Lindgren, A., & Johansson, B. A. (2015). Overrepresentation of unaccompanied refugee minors in inpatient psychiatric care. Springerplus, 4, 131. https://doi.org/10.1186/s40064-015-0902-1
Salas-Wright, C. P., Vaughn, M. G., Schwartz, S. J., & Cordova, D. (2016). An ‘immigrant paradox’’’ for adolescent externalizing behavior? Evidence from a national sample’. Social Psychiatry and Psychiatric Epidemiology, 51(1), 27–37. https://doi.org/10.1007/s00127-015-1115-1
Shek, D. T. L. (1998). A longitudinal study of the relations between parent-adolescent conflict and adolescent psychological well-being. Journal of Genetic Psychology, 159(1), 53–67.
Sleijpen, M., Boeije, H. R., Kleber, R. J., & Mooren, T. (2016). Between power and powerlessness: a meta-ethnography of sources of resilience in young refugees. Ethnicity & Health, 21(2), 158–180. https://doi.org/10.1080/13557858.2015.1044946
Smith, N. B., Kouros, C. D., & Meuret, A. E. (2014). The Role of Trauma Symptoms in Nonsuicidal Self-Injury. Trauma Violence & Abuse, 15(1), 41–56. https://doi.org/10.1177/1524838013496332
Swannell, S. V. (2014). Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression. Suicide Life Threat Behav, 44(3), 273. https://doi.org/10.1111/sltb.12070
Swannell, S. V., Martin, G. E., Page, A., Hasking, P., & St John, N. J. (2014). Prevalence of Nonsuicidal Self-Injury in Nonclinical Samples: Systematic Review, Meta-Analysis and Meta-Regression. Suicide and Life-Threatening Behavior, 44(3), 273–303. https://doi.org/10.1111/sltb.12070
Thommessen, S., Laghi, F., Cerrone, C., Baiocco, R., & Todd, B. K. (2013). Internalizing and externalizing symptoms among unaccompanied refugee and Italian adolescents. Children and Youth Services Review, 35(1), 7–10. https://doi.org/10.1016/j.childyouth.2012.10.007
United Nations High Commissioner for Refugees. (2010). Convention and Protocol Relating to the Status of Refugees. Retrieved 15 February 2017, from http://www.unhcr.org/protection/basic/3b66c2aa10/convention-protocol-re…
Victor, S. E., Styer, D., & Washburn, J. J. (2016). Functions of nonsuicidal self-injury (NSSI): Cross-sectional associations with NSSI duration and longitudinal changes over time and following treatment. Psychiatry Research, 241, 83–90. https://doi.org/10.1016/j.psychres.2016.04.083
Wade, J. (2011). Preparation and transition planning for unaccompanied asylum-seeking and refugee young people: A review of evidence in England. Children and Youth Services Review, 33(12), 2424–2430. https://doi.org/10.1016/j.childyouth.2011.08.027
Wester, K. L., & Trepal, H. C. (2015). Nonsuicidal Self-Injury: Exploring the Connection Among Race, Ethnic Identity, and Ethnic Belonging. Journal of College Student Development, 56(2), 127–139.
Whitlock, J. L., Eckenrode, J., & Silverman, D. (2006). Self-injurious behaviors in a college population. Pediatrics, 117(6), 1939–1948. https://doi.org/10.1542/peds.2005-2543
Whitlock, J. L., Exner-Cortens, D., & Purington, A. (2014). Assessment of nonsuicidal self-injury: development and initial validation of the Non-Suicidal Self-Injury-Assessment Tool (NSSI-AT). Psychological Assessment, 26(3), 935–946. https://doi.org/10.1037/a0036611
Whitlock, J. L., & Purington, A. (2013). The Brief Non-Suicidal Self-Injury Assessment Tool (BNSSI-AT). The Cornell Research Program on Self-Injury and Recovery. Retrieved from http://www.selfinjury.bctr.cornell.edu/perch/resources/bnssi-at-revised…
YouthInMind. (2016). Scoring the Strengths & Difficulties Questionnaire for age 4-17 or 18+. Retrieved from http://sdqinfo.org/py/sdqinfo/c0.py
Zetterqvist, M., Lundh, L.-G., Dahlström, Ö., & Svedin, C. G. (2013). Prevalence and Function of Non-Suicidal Self-Injury (NSSI) in a Community Sample of Adolescents, Using Suggested DSM-5 Criteria for a Potential NSSI Disorder. Journal of Abnormal Child Psychology, 41(5), 759–773. https://doi.org/10.1007/s10802-013-9712-5
Zetterqvist, M., Lundh, L.-G., & Svedin, C. G. (2013). A Comparison of Adolescents Engaging in Self-Injurious Behaviors With and Without Suicidal Intent: Self-Reported Experiences of Adverse Life Events and Trauma Symptoms. Journal of Youth and Adolescence, 42(8), 1257–1272. https://doi.org/10.1007/s10964-012-9872-6
