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Fatores psicológicos e familiares nos comportamentos autolesivos dos adolescentes: Da compreensão à intervenção em contexto escolar
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Os comportamentos autolesivos são um grave problema de saúde pública, especialmente entre adolescentes e jovens adultos, necessitando de intervenções preventivas eficazes. Estes comportamentos são influenciados por variáveis sociodemográficas, individuais e relacionais, sendo fundamental compreender melhor o papel dessas variáveis na promoção deste comportamento e desenvolver programas preventivos, particularmente em contextos escolares. Esta tese analisou como é que variáveis sociodemográficas (sexo e idade), individuais (perturbação de personalidade borderline, impulsividade e ideação suicida) e relacionais (funcionamento familiar) contribuem para os comportamentos autolesivos, bem como explora
os mecanismos que ligam o funcionamento familiar a estes comportamentos. Para além disso, foi desenvolvido e avaliado um programa de intervenção escolar para adolescentes, professores
e auxiliares educativos, com o objetivo de reduzir a prevalência de comportamentos autolesivos. O primeiro estudo validou a versão original da escala Borderline Personality Features Scale for Children para adolescentes, resultando na versão BPFSC-12, composta por 12 itens organizados em quatro fatores de primeira ordem (Instabilidade Afetiva, Problemas de Identidade, Relacionamentos Negativos e Autoagressão) e um fator de segunda ordem, "Características de Personalidade Borderline". Esta versão revelou-se uma medida válida e
fiável para a deteção precoce de perturbação de personalidade borderline em adolescentes. O segundo estudo explorou, a contribuição de variáveis sociodemográficas, relacionais e individuais para os comportamentos autolesivos. Observou-se que o género e a idade são preditores significativos, com as raparigas apresentando maior risco. No entanto, fatores intrapessoais, como a perturbação de personalidade borderline e a ideação suicida, mostraram um impacto mais forte na predisposição para estes comportamentos do que o funcionamento familiar. O terceiro estudo investigou se a perturbação de personalidade borderline e a ideação suicida atuam como mediadores entre o funcionamento familiar e os comportamentos
autolesivos. Verificou-se que ambos desempenham papéis mediadores significativos, com a ideação suicida como mediador total e a perturbação de personalidade borderline como mediador parcial. A mediação em série indicou que a relação entre o funcionamento familiar e os comportamentos autolesivos é totalmente mediada pela perturbação da personalidade borderline e pela ideação suicida.
No âmbito das intervenções, o programa “Healthy Minds” foi desenvolvido para prevenir comportamentos autolesivos em adolescentes em contexto escolar. O programa mostrou-se eficaz na redução das taxas destes comportamentos, na correção de crenças erradas, e na promoção da procura de ajuda profissional, embora sem impacto significativo no reconhecimento de sinais de alerta e na ideação suicida. Adicionalmente, foi implementado um programa de formação para professores e auxiliares educativos, capacitando-os para identificar e intervir em casos de comportamentos autolesivos. A intervenção mostrou-se eficaz na redução de falsas crenças, no aumento da capacidade de reconhecer sinais de alerta e na promoção de atitudes mais adaptativas em relação a estes comportamentos.
Em conclusão, esta tese contribui para a compreensão dos comportamentos autolesivos, destacando a importância de considerar tanto variáveis intrapessoais (como a perturbação de
personalidade borderline e a ideação suicida) quanto relacionais (como o funcionamento familiar). Reforça a necessidade de estratégias preventivas contínuas e integradas para reduzir a prevalência destes comportamentos e promover o bem-estar dos adolescentes, sublinhando a importância de programas eficazes em contexto escolar.
Deliberate self-harm is a serious public health problem, particularly among adolescents and young adults, and requires effective interventions to prevent it. These behaviours are influenced by socio-demographic, individual and relational variables and it is essential to better understand the role of these variables in the promotion of this behaviour and to develop prevention programmes, particularly in school contexts. This thesis analysed how socio-demographic (gender and age), individual (borderline personality disorder, impulsivity and suicidal ideation) and relational (family functioning) variables contribute to deliberate self-harm and explored the mechanisms linking family functioning to these behaviours. In addition, a school-based intervention programme for adolescents, teachers and educational assistants was developed and evaluated with the aim of reducing the prevalence of deliberate self-harm. The first study validated the original version of the Borderline Personality Features Scale for Children for adolescents, resulting in the BPFSC-12 version, which consists of 12 items grouped into four first-order factors (Affective Instability, Identity Problems, Negative Relationships and Self-harm) and a second-order factor, 'Borderline Personality Features'. This version proved to be a valid and reliable measure for the early detection of borderline personality disorder in adolescents. The second study examined the contribution of socio-demographic, relational and individual variables to deliberate self-harm. Gender and age were found to be significant predictors, with girls being at higher risk. However, intrapersonal factors such as borderline personality disorder and suicidal ideation showed a stronger effect on predisposition to these behaviours than family functioning. The third study examined whether borderline personality disorder and suicidal ideation act as mediators between family functioning and deliberate self-harm. Both were found to play a significant mediating role, with suicidal ideation acting as a full mediator and borderline personality disorder acting as a partial mediator. Serial mediation indicated that the relationship between family functioning and deliberate self-harm was fully mediated by borderline personality disorder and suicidal ideation. In terms of interventions, the Healthy Minds programme was developed to prevent deliberate self-harm among adolescents at school. The programme was found to be effective in reducing rates of these behaviours, reducing false beliefs, and promoting seeking professional help. However, it did not have a significant effect on recognising warning signs of DSH, nor on suicidal ideation In addition, a training programme for teachers and educational assistants was carried out to enable them to recognise and intervene in cases of deliberate self-harm. The intervention was found to be effective in reducing false beliefs, increasing the ability to recognise warning signs and promoting more adaptive attitudes towards these behaviours. In conclusion, this thesis contributes to the understanding of deliberate self-harm by highlighting the importance of considering both intrapersonal (such as borderline personality disorder and suicidal ideation) and relational (such as family functioning) variables. It reinforces the need for continuous and integrated preventive strategies to reduce the prevalence of these behaviours and promote adolescents' well-being and highlights the importance of effective programmes in the school context.
Deliberate self-harm is a serious public health problem, particularly among adolescents and young adults, and requires effective interventions to prevent it. These behaviours are influenced by socio-demographic, individual and relational variables and it is essential to better understand the role of these variables in the promotion of this behaviour and to develop prevention programmes, particularly in school contexts. This thesis analysed how socio-demographic (gender and age), individual (borderline personality disorder, impulsivity and suicidal ideation) and relational (family functioning) variables contribute to deliberate self-harm and explored the mechanisms linking family functioning to these behaviours. In addition, a school-based intervention programme for adolescents, teachers and educational assistants was developed and evaluated with the aim of reducing the prevalence of deliberate self-harm. The first study validated the original version of the Borderline Personality Features Scale for Children for adolescents, resulting in the BPFSC-12 version, which consists of 12 items grouped into four first-order factors (Affective Instability, Identity Problems, Negative Relationships and Self-harm) and a second-order factor, 'Borderline Personality Features'. This version proved to be a valid and reliable measure for the early detection of borderline personality disorder in adolescents. The second study examined the contribution of socio-demographic, relational and individual variables to deliberate self-harm. Gender and age were found to be significant predictors, with girls being at higher risk. However, intrapersonal factors such as borderline personality disorder and suicidal ideation showed a stronger effect on predisposition to these behaviours than family functioning. The third study examined whether borderline personality disorder and suicidal ideation act as mediators between family functioning and deliberate self-harm. Both were found to play a significant mediating role, with suicidal ideation acting as a full mediator and borderline personality disorder acting as a partial mediator. Serial mediation indicated that the relationship between family functioning and deliberate self-harm was fully mediated by borderline personality disorder and suicidal ideation. In terms of interventions, the Healthy Minds programme was developed to prevent deliberate self-harm among adolescents at school. The programme was found to be effective in reducing rates of these behaviours, reducing false beliefs, and promoting seeking professional help. However, it did not have a significant effect on recognising warning signs of DSH, nor on suicidal ideation In addition, a training programme for teachers and educational assistants was carried out to enable them to recognise and intervene in cases of deliberate self-harm. The intervention was found to be effective in reducing false beliefs, increasing the ability to recognise warning signs and promoting more adaptive attitudes towards these behaviours. In conclusion, this thesis contributes to the understanding of deliberate self-harm by highlighting the importance of considering both intrapersonal (such as borderline personality disorder and suicidal ideation) and relational (such as family functioning) variables. It reinforces the need for continuous and integrated preventive strategies to reduce the prevalence of these behaviours and promote adolescents' well-being and highlights the importance of effective programmes in the school context.
Description
Tese apresentada no Ispa - Instituto Universitário , para o grau de Doutor na área de especialização de Psicologia Clínica
Keywords
Comportamentos autolesivos Adolescência Saúde mental Prevenção em contexto escolar Deliberate self-harm Adolescence Mental health School-based prevention
Citation
Candeias, M. J. (2025). Fatores psicológicos e familiares nos comportamentos autolesivos dos adolescentes: Da compreensão à intervenção em contexto escolar [Tese de Doutoramento], Ispa - Instituto Universitário.