Psychische klachten bij jongeren: eerder regel dan uitzondering

Ine
Verbiest

85 748. Zo veel Vlaamse jongeren tussen de 12 en 17 jaar hebben te kampen met psychische moeilijkheden. Het is dus van belang om inzicht te krijgen in de onderliggende factoren om adolescenten preventief weerbaarder te maken en effectieve behandelingen op te stellen.

De adolescentie als kwetsbare periode

De adolescentie is de overgangsfase tussen de kindertijd en volwassenheid en gaat gepaard met meerdere biologische, psychologische en sociale veranderingen. Zo veranderen adolescenten op fysiek vlak, is er een stijging in het zoeken van opwinding en risico’s, zijn ze emotioneel instabieler, ervaren ze emoties frequenter én intenser, en willen ze onafhankelijker functioneren en zelfstandig beslissingen nemen. De combinatie van deze veranderingen hangt samen met een verschuiving in het psychisch welzijn van de adolescent. Hierdoor zijn adolescenten kwetsbaarder voor de ontwikkeling van mentale problemen zoals angst, alcohol- en drugsmisbruik, en depressie. Deze kwetsbaarheid is te zien in een duidelijke stijging van verschillende psychische symptomen wanneer jongeren de leeftijd van 10 jaar bereiken.

Eerder regel dan uitzondering 

De Wereld Gezondheidsorganisatie schat dat één op de vijf adolescenten minstens één psychische problematiek heeft. In Vlaanderen gaat dit over maar liefst 85 748 jongeren. Een Amerikaanse studie die jonge adolescenten jaarlijks onderzocht tot ze 21 jaar werden, vond zelfs een life-time prevalentie van 82,5%. Dit wil zeggen dat de kans om gedurende heel deze periode aan minstens één psychische stoornis te lijden 82,5% is. Het is dus eerder de regel dan de uitzondering om psychische klachten te ervaren.

Het waait wel over?

Aangezien het hebben van psychische problemen tijdens de adolescentie zowel op korte als lange termijn een nefaste impact heeft, is het van groot belang zicht te krijgen op welke mechanismen hier een rol in spelen. Het probleem negeren en wachten tot het overwaait, is hier niet de oplossing.

Een eerste belangrijke factor die een invloed heeft op de psychische gezondheid van jongeren is de vaardigheid om hun emoties te reguleren. Het doel van emotieregulatie is negatieve emoties naar beneden halen en positieve emoties naar boven brengen. Om daadwerkelijk emoties te kunnen reguleren, worden bepaalde strategieën gebruikt. Adaptieve (‘goede’) strategieën zoals afleiding en probleemoplossing maken de kans op de ontwikkeling van psychische problemen kleiner. De maladaptieve (‘slechte’) strategieën, bijvoorbeeld piekeren en opgeven, zijn risicofactoren voor de ontwikkeling van psychopathologie. Het is dus van belang dat adolescenten over voldoende adaptieve strategieën beschikken en zo min mogelijk gebruik maken van de maladaptieve strategieën.

Gevoelens

Het gebruik van bepaalde emotieregulatiestrategieën speelt een centrale rol binnen de ontwikkeling, instandhouding en remissie van verschillende stoornissen. De rol van deze strategieën verder onderzoeken is van belang voor de preventie en behandeling van psychische stoornissen bij adolescenten. Zo is een gebrekkige emotieregulatie in verschillende studies gelinkt aan psychopathologie, maar is de impact niet steeds even groot in elke studie. Piekeren zal bijvoorbeeld bij de ene studie zeer sterk gelinkt zijn aan depressieve gevoelens terwijl deze link in een ander onderzoek minder sterk is. De vraag kan dus gesteld worden welke factoren een versterkende of verzwakkende invloed hebben. Een mogelijk beïnvloedende factor op de relatie tussen emotieregulatie en psychische problemen is het executief functioneren van de adolescent.

Executief watte?

Executieve functies zijn cognitieve processen die nodig zijn om gedrag doelgericht te sturen. Ze zijn belangrijk voor veel aspecten in het dagdagelijks leven, zoals plannen maken, beslissingen nemen en prioriteiten stellen. Globaal genomen zijn er drie kern executieve functies: inhibitie, werkgeheugen en cognitieve flexibiliteit. Inhibitie zorgt er voor dat we in staat zijn ons eigen gedrag, aandacht en/of gedachten te controleren, om op die manier te doen wat verwacht wordt of gepast is. Inhibitie kan dus gezien worden als een ‘rem’ op onze automatische reflex. Het werkgeheugen wordt gebruikt voor het tijdelijk opslaan en manipuleren van informatie, nodig om bijvoorbeeld een optelsom te maken. Cognitieve flexibiliteit maakt het mogelijk om te kunnen switchen naar een andere gedachte of actie. Verscheidene mentale stoornissen, waaronder depressie, verslaving, angst, ADHD en schizofrenie, worden gekenmerkt door moeilijkheden met één of meer van deze drie executieve functies.

Samenspel 

Zowel emotieregulatie als executief functioneren zorgen voor het reguleren van gedachten, gevoelens en/of gedragingen. Ze zijn beide gerelateerd aan verschillende vormen van psychopathologie. Recent onderzoek bij jonge adolescenten ging na of ze ook een invloed hebben op elkaar.

Dit laatste blijkt het geval te zijn. Zo heeft het executief functioneren van de adolescent een invloed op het verband tussen adaptieve emotieregulatiestrategieën en internaliserende problemen zoals angst en depressie. Jongeren met weinig adaptieve strategieën én veel executieve functie moeilijkheden, vertonen meer internaliserende problemen dan jongeren die ook weinig adaptieve strategieën hebben maar geen executieve functie moeilijkheden ervaren. Er is hier dus sprake van een samenspel tussen emotieregulatie en executief functioneren.

Geen overbodige luxe

Aangezien emotieregulatie wordt beïnvloed door het executief functioneren van de adolescent is het van belang om ook aan de slag te gaan met de executieve functies en niet enkel adaptieve emotieregulatiestrategieën aan te leren. Daarnaast lijkt het meer aangewezen om, in plaats van te focussen op specifieke behandelingen per stoornis, een transdiagnostische benadering te hanteren. Deze benaderingen focussen zich op problemen met onderliggende mechanismen, zoals emotieregulatie en executief functioneren, die afzonderlijke stoornissen met elkaar gemeen hebben.

Het (preventief) geven van trainingen waarin adolescenten hun emotieregulatie en/of executief functioneren verbeteren, kan een positieve impact hebben op veel verschillende psychische symptomen. Investeren in dit soort preventie en behandelingen is geen overbodige luxe als we het cijfer van 85 748 jongeren willen doen dalen.

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Universiteit of Hogeschool
Universiteit Gent
Thesis jaar
2020
Promotor(en)
Dr. Laura Wante