Uma abordagem longitudinal da contribuição do trauma e da vergonha nos sintomas depressivos em adolescentes

  • Marina Cunha Instituto Superior Miguel Torga, Coimbra Centro de Investigação em Neuropsicologia e Intervenção Cognitivo-comportamental, Universidade Coimbra http://orcid.org/0000-0002-5957-1903
  • Rute Almeida Instituto Piaget de Viseu Instituto Superior Miguel Torga, Coimbra http://orcid.org/0000-0003-1994-6069
  • Sónia Cherpe Centro de Investigação em Neuropsicologia e Intervenção Cognitivo-comportamental, Universidade de Coimbra http://orcid.org/0000-0001-8248-3488
  • Sónia Simões Instituto Superior Miguel Torga, Coimbra http://orcid.org/0000-0002-6691-7941
  • Mariana Marques Serviço de psicologia médica, Universidade de Coimbra Instituto Superior Miguel Torga, Coimbra Centro Hospitalar e Universitário de Coimbra EPE, Coimbra http://orcid.org/0000-0002-7856-280X
Palavras-chave: Depressão, Adolescentes, Acontecimentos traumáticos, Sentimentos de vergonha, Estudo longitudinal

Resumo

Contexto: A revisão da literatura sobre potenciais fatores preditores dos sintomas depressivos em adolescentes tem mostrado que asexperiências traumáticas durante a infância, as experiências de vergonha e o género têm um contributo relevante.

Objetivo: Pretende-se com o presente estudoobservar a variabilidade intraindividual da vergonha, acontecimentos traumáticos e género e testar o poder preditivo destas variáveis a 6 meses na evolução de sintomas depressivos (variável dependente) em adolescentes.

Método: A amostra foi constituída por 325 adolescentes, com idades compreendidas entre os 12 e os 18 anos, distribuídos pela zona centro de Portugal e a frequentar o 3.º ciclo do ensino básico e ensino secundário. Foram utilizados o Inventário de Depressão para Crianças, a Escala Breve de vergonha e o Questionário de Trauma na Infância para a avaliação das variáveis referidas. Os resultados longitudinais foram analisados através de uma análise de regressão linear múltipla. 

Resultados: Verificou-se uma associação positiva entre experiências relatadas como traumáticas e as perceções de vergonha (T1) e os sintomas depressivos (T2, após 6 meses). O modelo de regressão linear múltipla explicou 63% da variância dos sintomas depressivos no T2, podendo contemplar-se que a pertença ao género feminino, a experiência de sentimentos de vergonha e de acontecimentos percebidos como abuso afetivo, abuso sexual e de negligência emocional (variáveis do trauma) permitiram predizer sintomas depressivos na adolescência.

Conclusão: Dado que existe alguma evidência do impacto de acontecimentos traumáticos do tipo abuso/negligência durante a infância e de perceções de vergonha, durante a adolescência no desenvolvimento de sintomas depressivos, será pertinente que estas variáveis sejam tidas em conta, quer na avaliação, quer nas intervenções psicoterapêuticas nesta etapa do desenvolvimento humano. Este estudo contribui para salientar o papel de fatores de vulnerabilidade para os sintomas depressivos na adolescência.

Downloads

Não há dados estatísticos.

Biografias Autor

Marina Cunha, Instituto Superior Miguel Torga, Coimbra Centro de Investigação em Neuropsicologia e Intervenção Cognitivo-comportamental, Universidade Coimbra

Professora auxiliar em Psicologia

Presidente do Conselho Científico do Instituto Superior Miguel Torga

 

Rute Almeida, Instituto Piaget de Viseu Instituto Superior Miguel Torga, Coimbra

Licenciada em Psicologia, Instituto Piaget de Viseu

Mestre em Psicologia Clinica, Ramo Terapia-Cognitivo Comportamental, Instituto Superior Miguel Torga, Coimbra

Sónia Cherpe, Centro de Investigação em Neuropsicologia e Intervenção Cognitivo-comportamental, Universidade de Coimbra

Doutorada em Psicologia

Psicóloga na Depression and Bipolar Support Association: Coimbra

Sónia Simões, Instituto Superior Miguel Torga, Coimbra

Doutorada em Saúde Mental

Coordenadora do Gabinete de Apoio Psicológico, Instituto Superior Miguel Torga

Mariana Marques, Serviço de psicologia médica, Universidade de Coimbra Instituto Superior Miguel Torga, Coimbra Centro Hospitalar e Universitário de Coimbra EPE, Coimbra

Professora auxiliar

Psicóloga no Centro Hospitalar e Universitário de Coimbra EPE, Coimbra

Referências

Ahmed, S. P., Bittencourt-Hewitt, A., & Sebastian, C. L. (2015). Neurocognitive bases of emotion regulation development in adolescence. Developmental Cognitive Neuroscience, 15, 11–25. https://doi.org/10.1016/j.dcn.2015.07.006

Andrews, B., Qian, M., &Valentine, D. J. (2002). Predicting depressive symptoms with a new measure of shame: The Experience of Shame Scale. British Journal of Clinical Psychology, 41(1), 29–42. https://doi.org/10.1348/014466502163778

Åslund, C., Nilsson, K. W., Starrin, B., & Sjöberg, R. L. (2007). Shaming experiences and the association between adolescent depression and psychosocial risk factors. European Child and Adolescent Psychiatry, 16(5), 298–304. https://doi.org/10.1007/s00787-006-0564-1

Balsamo, M., Macchia, A., Carlucci, L., Picconi, L., Tommasi, M., Gilbert, P., & Saggino, A. (2015). Measurement of external shame: An inside view. Journal of Personality Assessment, 97(1), 81–89. https://doi.org/10.1080/00223891.2014.947650

Barry, M., Murphy, M., & O’Donovan, H. (2017). Assessing the effectiveness of a cognitive behavioural group coaching intervention in reducing symptoms of depression among adolescent males in a school setting. International Coaching Psychology Review, 12(2), 101–109. Retrieved from http://psycnet.apa.org/record/2018-01291-003

Bennett, D. S., Sullivan, M. W., & Lewis, M. (2010). Neglect children, shame-proneness, and depressive symptoms. Child Maltreatment, 15(4), 305–314. https://doi.org/10.1177/1077559510379634

Bernstein, D. P., & Fink, L. (1998). Childhood Trauma Questionnaire: A retrospective self-report manual. San Antonio, TX: The Psychological Corporation.

Bonanno, G. A., Keltner, D., Noll, J. G., Putnam, F. W., Trickett, P. K., LeJeune, J., & Anderson, C. (2002). When the face reveals what words do not: Facial expressions of emotion, smiling, and the willingness to disclose childhood sexual abuse. Journal of Personality and Social Psychology, 83(1), 94–110. https://doi.org/10.1037/0022-3514.83.1.94

Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., … Zule, W. (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect, 27(2), 169–190. https://doi.org/10.1016/S0145-2134(02)00541-0

Cardoso, P. M. S., Rodrigues, C., & Vilar, A. (2004). Prevalência de sintomas depressivos em adolescentes portugueses. Análise Psicológica, 22(4), 667–675. https://doi.org/10.14417/ap.264

Cherpe, S., Matos, A. P., & Pereira, A. (2010). Versão Portuguesa do Childhood Trauma Questionnaire [Portuguese version of the Childhood Trauma Questionnaire]. Manuscrito não publicado, Faculdade de Psicologia e Ciências da Educação da Universidade de Coimbra, Portugal.

Costello, E. J., Copeland, W., & Angold, A. (2011). Trends in psychopathology across the adolescent years: What changes when children become adolescents, and when adolescents become adults? Journal of Child Psychology and Psychiatry, 52(10), 1015–1025. https://doi.org/10.1111/j.1469-7610.2011.02446.x

Cunha, M., Matos, M., Faria, D., & Zagalo, S. (2012). Shame memories and psychopathology in adolescence: The mediator effect of shame. International Journal of Psychology & Psychological Therapy, 12(2), 203–218. Retrieved from http://www.ijpsy.com/volumen12/num2/327/shame-memories-and-psychopathologyin-adolescence-EN.pdf

Cunha, M., Xavier, A. M. J., Cherpe, S., & Pinto-Gouveia, J. (2017). Assessment of shame in adolescents: The ‘Other as Shamer’ Scale. Psicologia: Teoria e Pesquisa, 33, 1–9. https://doi.org/10.1590/0102.3772e3336

Dahl, R. E. (2004). Adolescent brain development: A period of vulnerabilities and opportunities. Keynote address. Annals of the New York Academy of Sciences, 1021(1), 1–22. https://doi.org/10.1196/annals.1308.001

De Rubeis, S., & Hollenstein, T. (2009). Individual differences in shame and depressive symptoms during early adolescence. Personality and Individual Differences, 46(4), 477–482. https://doi.org/10.1016/j.paid.2008.11.019

Dunn, E. C., McLaughlin, K. A., Slopen, N., Rosand, J., & Smoller, J. W. (2013). Developmental timing of child maltreatment and symptoms of depression and suicidal ideation in young adulthood: Results from the National Longitudinal Study on Adolescent Health. Depression and Anxiety, 30(10), 955–964. https://doi.org/10.1002/da.22102

English, D. J., Widom, C. S., & Brandford, C. (2004). Another look at the effects of child abuse. National Institute of Justice Journal, 251, 23–24. Retrieved from https://www.ncjrs.gov/pdffiles1/jr000251g.pdf

Feiring, C. (2005). Emotional development, shame, and adaptation to child maltreatment. Child Maltreatment, 10(4), 307–310. https://doi.org/10.1177/1077559505281307

Firth, M. T. (2014). Childhood abuse and depressive vulnerability in clients with gender dysphoria. Counselling and Psychotherapy Research, 14(4), 297–305. https://doi.org/10.1080/14733145.2013.845236

Grassi-Oliveira, R., Stein, L. M., & Pezzi, J. C. (2006). Tradução e validação de conteúdo da versão em português do Childhood Trauma Questionnaire [Translation and content validation of the Childhood Trauma Questionnaire into Portuguese language]. Revista de Saúde Pública, 40(2) 249–255. https://doi.org/10.1590/S0034-89102006000200010

Gibb, B. E., Alloy, L. B., Abramson, L. Y., Rose, D. T., Whitehouse, W. G., Donovan, P., … Tierney, S. (2001). History of childhood maltreatment, negative cognitive style, and episodes of depression in adulthood. Cognitive Therapy and Research, 25(4), 425–446. Retrieved from https://sites.temple.edu/moodandcognitionlab/files/2014/01/Gibb-et-al.-2001a.pdf

Gilbert, P. (1998). What is shame? Some core issues and controversies. In P. Gilbert & B. Andrews (Eds.), Shame: Interpersonal behavior, psychopathology, and culture (pp. 3–38). New York, NY: Oxford University Press.

Gilbert, P. (2002). Understanding the biopsychosocial approach: Conceptualization. Clinical Psychology, 14, 13–17. Retrieved from http://www.critpsynet.freeuk.com/Gilbert.htm

Gilbert, P. (2006). A biopsychosocial and evolutionary approach to formulation with a special focus on shame. In N. Tarrier (Ed.), Case formulation in cognitive behaviour therapy: The treatment of challenging and complex cases (pp. 81–112). New York, NY: Routledge/Taylor & Francis Group.

Gilbert, P., & Irons, C., (2009). Shame, self-criticism, and self-compassion in adolescence. In N. Allen (Ed.), Psychopathology in adolescence. Cambridge: Cambridge University Press.

Gore, F. M., Bloem, P. J., Patton, G. C., Ferguson, J., Joseph, V., Coffey, C., ... Mathers, C. D. (2011). Global burden of disease in young people aged 10–24 years: A systematic analysis. The Lancet, 377(9783), 2093-2102. https://doi.org/10.1016/S0140-6736(11)60512-6

Goss, K., Gilbert, P., & Allan, S. (1994). An exploration of shame measures – I: The Other as Shamer Scale. Personality and Individual Differences, 17(5), 713–717. https://doi.org/10.1016/0191-8869(94)90149-X

Hopwood, C. J., Ansell, E. B., Fehon, D. C., & Grilo, C. M. (2011). The mediational significance of negative/depressive affect in the relationship of childhood maltreatment and eating disorder features in adolescent psychiatric inpatients. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 16(1), e9–e16. https://doi.org/10.1007/BF03327515

Infurna, F. J., Rivers, C. T., Reich, J., & Zautra, A. J. (2015). Childhood trauma and personal mastery: Their influence on emotional reactivity to everyday events in a community sample of middle-aged adults. PLoS ONE, 10(4), e0121840. https://doi.org/10.1371/journal.pone.0121840

Irons, C., & Gilbert, P. (2005). Evolved mechanisms in adolescent anxiety and depression symptoms: The role of the attachment and social rank systems. Journal of Adolescence, 28(3), 325–341. https://doi.org/10.1016/j.adolescence.2004.07.004

Kim, J., & Cicchetti, D. (2006). Longitudinal trajectories of self-system processes and depressive symptoms among maltreated and nonmaltreated children. Child Development, 77(3), 624–639. https://doi.org/10.1111/j.1467-8624.2006.00894.x

Kim, J., Talbot, N. L., & Cicchetti, D. (2009). Childhood abuse and current interpersonal conflict: The role of shame. Child Abuse & Neglect, 33(6), 362–371. https://doi.org/10.1016/j.chiabu.2008.10.003

Kline, R. B. (2005). Principles and practice of structural equation modeling (2nd ed.). New York, NY: Guilford Press.

Kovacs, M. (1985). The Children's Depression Inventory (CDI). Psychopharmacology Bulletin, 21(4), 995-998.

Liu, R. T., Alloy, L. B., Abramson, L. Y., Iacoviello, B. M., & Whitehouse, W. G. (2009). Emotional maltreatment and depression: Prospetive prediction of depressive episodes. Depression and Anxiety, 26(2), 174-181. https://doi.org/10.1002/da.20545

Lopes, B., Pinto-Gouveia, J., & Castilho, P. (2005). Portuguese version of the Others as Shamer Scale. Unpublish manuscript.

Mandelli, L., Petrelli, C., & Serretti, A. (2015). The role of specific early trauma in adult depression: A meta-analysis of published literature. Childhood trauma and adult depression. European Psychiatry, 30(6), 665–680. https://doi.org/10.1016/j.eurpsy.2015.04.007

Marôco, J. (2011). Análise estatística com o SPSS Statistics [Statistical analysis with SPSS Statistics] (5th ed.). Pero Pinheiro: Report Number.

Matos, M., & Pinto-Gouveia, J. (2010). Shame as a traumatic memory. Clinical Psychology and Psychotherapy, 17(4), 299–312. https://doi.org/10.1002/cpp.659

Matos, M., Pinto-Gouveia, J., & Duarte, C. (2012). When I don't like myself: Portuguese version of the internalized shame scale. The Spanish Journal of Psychology, 15(3), 1411–1423. https://doi.org/10.5209/rev_SJOP.2012.v15.n3.39425

Matos, M., Pinto-Gouveia, J., & Duarte, C. (2013). Internalizing early memories of shame and lack of safeness and warmth: The mediating role of shame on depression. Behavioural and Cognitive Psychotherapy, 41(4), 479–493. https://doi.org/10.1017/S1352465812001099

Marujo, H. (1994). Síndromas depressivos na infância e na adolescência [Depressive syndromes in childhood and adolescence] (Unpublished doctoral dissertation). Faculdade de Psicologia e Ciências da Educação da Universidade de Lisboa, Lisboa, Portugal.

McLean, K. C., Breen, A. V., & Fournier, M. A. (2010). Constructing the self in early, middle, and late adolescent boys: Narrative identity, individuation, and well-being. Journal of Research on Adolescence, 20(1), 166-187. https://doi.org/10.1111/j.1532-7795.2009.00633.x

Monteiro, S., Matos, A. P., & Oliveira, S. (2015). The moderating effect of gender: Traumatic experiences and depression in adolescence. Procedia - Social and Behavioral Sciences, 165, 251–259. https://doi.org/10.1016/j.sbspro.2014.12.629

Moylan, C. A., Herrenkohl, T. I., Sousa, C., Tajima, E. A., Herrenkohl, R. C., & Russo, M. J. (2010). The effects of child abuse and exposure to domestic violence on adolescent internalizing and externalizing behavior problems. Journal of Family Violence, 25(1), 53–63. https://doi.org/10.1007/s10896-009-9269-9

Muris, P., Meesters, C., Heijmans, J., van Hulten, S., Kaanen, L., Oerlemans, B., ... Tielemans, T. (2016). Lack of guilt, guilt, and shame: A multi-informant study on the relations between self-conscious emotions and psychopathology in clinically referred children and adolescents. European Child & Adolescent Psychiatry, 25(4), 383–396. https://doi.org/10.1007/s00787-015-0749-6

Muris, P., & Meesters, C. (2014). Small or big in the eyes of the other: On the developmental psychopathology of self-conscious emotions as shame, guilt, and pride. Clinical Child and Family Psychology Review, 17(1), 19–40. https://doi.org/10.1007/s10567-013-0137-z

Musliner, K. L., & Singer, J. B. (2014) Emotional support and adult depression in survivors of childhood sexual abuse. Child Abuse & Neglect, 38(8), 1331–1340. https://doi.org/10.1016/j.chiabu.2014.01.016

Negrao, C., Bonanno, A. G., Noll, J. G., Putnam, F. W., & Trickett, P. K. (2005). Shame, humiliation, and childhood sexual abuse: Distinct contributions and emotional coherence. Child Maltreatment, 10(4), 350–363. https://doi.org/10.1177/1077559505279366

Papalia, D. E., Olds, S. W., & Feldman, R. D. (2006). Desenvolvimento Humano (8th ed.). Porto Alegre: Artmed.

Pallant, J. (2013). SPSS survival manual: A step by step guide to data analysis using IBM SPSS (5th ed.). Crows Nest, NSW: Allen & Unwin.

Pereira, I. M., Matos, A. P., & Azevedo, A. (2014). Versão portuguesa do Questionário de Pensamentos Automáticos-Revisto: Relação com sintomatologia depressiva em adolescentes [Portuguese version of the automatic thoughts questionnaires – revised: Relation with depressive symptomatology in adolescents]. Psicologia, Saúde & Doenças, 15(1), 36–46. https://doi.org/10.15309/14psd150105

Pinquart, M., & Shen, Y. (2011). Depressive symptoms in children and adolescents with chronic physical illness: An updated meta-analysis. Journal of Pediatric Psychology, 36(4), 375–384. https://doi.org/10.1093/jpepsy/jsq104

Price, M., Higa-McMillan, C., Kim, S., & Frueh, C. (2013). Trauma experience in children and adolescents: An assessment of the effects of trauma type and role of interpersonal proximity. Journal of Anxiety Disorders, 27(7), 652-660. 652–660. https://doi.org/10.1016/j.janxdis.2013.07.009

Rosso, A. D., Beber, S., Bianco, F., Gregorio, D. D., Paolo, M. D., Lauriola, A. L., … Basile, B. (2014). La vergogna in psicopatologia [Shame in psychopathology]. Cognitivismo Clinico, 11(1), 27–61. Retrieved from http://www.fioriti.it/riviste/pdf/2/14-1DelRossoweb.pdf

Shore, L., Toumbourou, J. W., Lewis, A. J., & Kremer, P. (2018). Longitudinal trajectories of child and adolescent depressive symptoms and their predictors – A systematic review and meta‐analysis. Child and Adolescent Mental Health, 23(2), 107-120. https://doi.org/10.1111/camh.12220

Slep, A. M. S., Heyman, R. E., & Snarr, J. D. (2011). Child emotional agression and abuse: Definitions and prevalence. Child Abuse & Neglect, 35(10), 783–796. https://doi.org/10.1016/j.chiabu.2011.07.002

Sousa, C., Herrenkohl, T. I., Moylan, C. A., Tajima, E. A., Klika, J. B., Herrenkohl, R. C., & Russo, M. J. (2011). Longitudinal study on the effects of child abuse and children’s exposure to domestic violence, parent-child attachments, and antisocial behavior in adolescence. Journal Interpersonal Violence, 26(1), 111–136. https://doi.org/10.1177/0886260510362883

Spinhoven, P., Penninx, B. W., Hickendorff, M., van Hemert, A. M., Bernstein, D. P., & Elzinga, B. M. (2014). Childhood Trauma Questionnaire: Factor structure, measurement invariance, and validity across emotional disorders. Psychological Assessment, 26(3), 717-729. https://doi.org/10.1037/pas0000002

Steinberg, L. (2005). Cognitive and affective development in adolescence. Trends in Cognitive Sciences, 9(2), 69-74. https://doi.org 10.1016/j.tics.2004.12.005

Stuewing, J., & McCloskey, L. A. (2005). The relation of child maltreatment to shame and guilt among adolescents: Psychological routes to depression and delinquency. Child Maltreatment, 10(4), 324–336. https://doi.org/10.1177/1077559505279308

Steinberg, L. (2010). A behavioral scientist looks at the science of adolescent brain development. Brain and Cognition, 72(1), 160–164. https://doi.org/10.1016/j.bandc.2009.11.003

Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Boston: Pearson Education Inc.

Tangney, J. P., & Dearing, R. L. (2002). Shame and guilt (1st ed.). New York, NY: Guilford Press.

Thapar, A., Collishaw, S., Pine, D. S., & Thapar, A. K. (2012). Depression in adolescence. The Lancet, 379(9820), 1056-1067. https://doi.org/10.1016/S0140-6736(11)60871-4

Szentágotai-Tătar, A., Chis, A., Vulturar, R., Dobrean, A., Cândea, D. M., & Miu, A. C. (2015). Shame and guilt-proneness in adolescents: Gene-environment interactions. PLoS ONE, 10(7), e0134716. https://doi.org/10.1371/journal.pone.0134716

Tolchinsky, A. (2014). Acute trauma in adulthood in the context of childhood traumatic experiences. Neuropsychoanalysis: An Interdisciplinary Journal for Psychoanalysis and the Neurosciences, 16(2), 129–137. https://doi.org/10.1080/15294145.2014.963645

World Health Organization. (2018). Adolescents: Health risks and solutions. Retrieved from http://www.who.int/mediacentre/factsheets/fs345/en/

Publicado
2018-10-01
Como Citar
Cunha, M., Almeida, R., Cherpe, S., Simões, S., & Marques, M. (2018). Uma abordagem longitudinal da contribuição do trauma e da vergonha nos sintomas depressivos em adolescentes. Revista Portuguesa De Investigação Comportamental E Social, 4(2), 49-59. https://doi.org/10.31211/rpics.2018.4.2.62
Secção
Artigo Original