Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A tese tem o objetivo de apresentar a Pedagogia Cemiterial como proposta de ação a ser desenvolvida no ensino básico. A metodologia escolhida fundamenta-se na metanálise de dados do Censo de 2010, referentes ao perfil religioso dos/das adolescentes brasileiros e na pesquisa etnográfica virtual, através do monitoramento de Páginas Comunitárias do Facebook ligadas ao incentivo e extinção do comportamento autolesivo e suicidário entre adolescentes brasileiros (as) de 13-17 anos de idade. A estrutura foi dividida em quatro capítulos distintos. O primeiro apresenta o indivíduo, na fase da adolescência, a partir do modelo bioecológico de Bronfenbrenner e como este se insere nos estágios da fé e o Deus Google. O segundo verifica a percepção de morte e morrer do/da adolescente virtualizado (a), bem como sua interação com as Páginas Comunitárias do Facebook associadas ao incentivo e extinção do comportamento autolesivo. O terceiro analisa a importância do Ensino Religioso como componente curricular compatível ao desenvolvimento do tema da morte e do morrer no espaço escolar através da Pedagogia Cemiterial. Por fim, o último capítulo propõe um modelo de ação para a aplicação da Pedagogia Cemiterial com adolescentes no espaço escolar. / The goal of this dissertation is to present the Cemeterial Pedagogy as a proposal for action to be developed in primary education. The methodology chosen is founded on the meta-analysis of data from the 2010 Census, regarding the religious profile of Brazilian adolescents and on the virtual ethnographic research, through the monitoring of Community Facebook pages connected to the encouragement and extinction of self-injurious and suicidal behavior among Brazilian adolescents ages 13 to 17. The structure was divided into four distinct chapters. The first presents the individual, in the adolescent phase, based on the bio-ecological model of Bronfenbrenner and how this adolescent inserts him/herself in the faith stages and the Google God. The second verifies the perception of death and dying of the virtualized adolescent as well as his or her interaction with Community Facebook pages associated to the encouragement and extinction of self-injurious behavior. The third analyzes the importance of Religious Education as a curricular component that is compatible to the development of the theme of death and dying in the school space through the Cemeterial Pedagogy. Finally, the last chapter proposes a model of action for the application of the Cemeterial Pedagogy with adolescents in the school space.

Contexto: Pouco se sabe a respeito da prevalência e correlatos de autolesão deliberada em jovens de países em desenvolvimento. Além disso, existe uma escassez de estudos avaliando associações clínicas e com psicopatologia familiar ajustando-se para outras comorbidades, especialmente numa faixa etária mais jovem da população (dos 6 aos 14 anos). Objetivos: Nós investigamos a prevalência e as associações de autolesão deliberada em jo- vens desta faixa etária com fatores de risco demográficos (idade, gênero, status socioeconô- mico e etnicidade), clínico (diagnóstico psiquiátrico das crianças) e familiar (diagnóstico psiquiátrico materno) em um grande estudo comunitário no Brasil. Métodos: Participantes (n=2.508) e suas mães (n=2,295) da Coorte de Alto-Risco para Transtornos Psiquiátricos foram avaliados através da Development and Well Being Assess- ment (DAWBA) e Mini International Neuropsychiatric Interview (MINI) respectivamente. Autolesão atual (no último mês) e ao longo da vida foram estimadas, incluindo análises estratificadas por faixa etária. Regressões logísticas foram realizadas investigando o papel do diagnóstico clínico de crianças e adolescentes e da psicopatologia materna sobre as estimativas de autolesão, ajustando-se para potenciais fatores confundidores. Resultados: A prevalência de autolesão deliberada atual foi de 0,8% (0,6% para crianças e 1% para adolescentes) e ao longo da vida foi de 1,6% (1,8% e 1,5% respectivamente). Estas estimativas não variaram de acordo com a idade, sexo e etnicidade. No entanto, pertencer à classe média esteve associado a uma diminuição de 70% na probabilidade de se relatar um episódio de autolesão ao longo da vida comparando-se com a classe mais favorecida. Autolesão atual e ao longo da vida foram mais frequentes em jovens com Depressão Maior, Transtorno de Déficit de Atenção e Hiperatividade (TDAH) e Transtorno Opositor Desafiante (TOD), mesmo em modelos múltiplos ajustado para variáveis demográficas e co- ocorrência de transtornos psiquiátricos. Além disso, a presença de transtorno de ansiedade nas mães esteve fortemente associada com autolesão deliberada recente e ao longo da vida em seus descendentes. Ao estratificar-se a análise por faixa etária, esta associação tornou- se não significativa para crianças com autolesão recente e adolescentes com autolesão ao longo da vida; ao passo que, especificamente em crianças, autolesão recente foi associada com transtorno de humor materno. Conclusão: A autolesão deliberada é um problema importante em crianças e adolescen- tes. Os diagnósticos de Depressão Maior, TDAH e TOD estão consistentemente associados com este comportamento, bem como ter uma mãe com um transtorno de ansiedade. Nos- sos resultados salientam a importância de se perguntar a respeito de comportamentos suicidas em jovens com comportamentos disruptivos, independentemente da comorbidade com depressão, e também realçam a necessidade de estratégias preventivas com um en- volvimento familiar. / Background: Little is known about the prevalence and correlates of deliberate self-harm (DSH) in youngsters from low and middle-income countries. In addition, there is a shortage of studies evaluating clinical associations and family psychopathology adjusting for other comorbidities, especially in a younger age-group (from 6 to 14 years). Objectives: We investigated prevalence and associations of DSH in youngsters of that age range with demographic (age, gender, socioeconomic status and ethnicity), clinical (children psychiatric diagnosis) and familial risk factors (maternal psychiatric diagnosis) from a community-based study from Brazil. Methods: Participants (n=2,508) and their mothers (n=2,295) from the High Risk Co- hort for Psychiatric Disorders (HRC) were assessed through the Development andWell Be- ing Assessment (DAWBA) and the Mini International Neuropsychiatric Interview (MINI) respectively. Current (last month) and lifetime DSH were estimated, including analysis stratified by age-groups. Logistic regressions were performed investigating the role of youths’ clinical diagnoses and maternal psychopathology on prevalence estimates of DSH adjusting for potential confounding factors. Results: Prevalence of current DSH was 0.8% (0.6% for children and 1% for adolescents) and life-time DSH was 1.6% (1.8% and 1.5% respectively). These estimatives did not vary with age, gender and ethnicity. However, being from middle class was associated with a 70% decrease in the odds of reporting a lifetime episode of DSH comparing to the wealthiest class. Current and life-time DSH was more frequent in youth with Major Depression, Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD), even in multiple models accounting for demographic variables and co- occurring psychiatric disorders. Anxiety in mothers was strongly associated with current and life-time DSH in the offspring but when stratifying by age-group this association becomes non-significant for children with current DSH and for adolescents with lifetime DSH, whereas current DSH was associated with maternal mood disorder specifically in young children. Conclusion: Diagnoses of Major Depression, ADHD and ODD are consistently associated with DSH as well as having a mother with anxiety disorder. Our results emphasize the necessity to ask about suicidal behavior in young people with disruptive behaviors, regard- less of comorbidity with depression, and also highlight the need for preventive strategies with a family component.

Many children diagnosed with autism spectrum disorder (ASD) engage in problem behaviors (e.g., aggression and self-injurious behavior) that present safety concerns for both the children themselves and others around them. Previous research has shown that treating precursor behaviors that precede problem behavior may prove to be an alternative, safer method for preventing and treating problem behavior. The present study used a multiple baseline design across subjects (n = 4) to assess the efficacy of relaxation interventions on reducing precursor behavior and preventing problem behavior in children with ASD. Researchers first identified precursor behaviors for all participants through observation. During the intervention phase, all four children were taught deep breathing relaxation exercises. After participants received relaxation training, researchers cued relaxation exercises when precursors occurred, and the frequency of precursor, problem, and on-task behavior was observed. Results showed that problem behavior decreased in all participants following the relaxation intervention. Additionally, for the majority of participants, precursor behavior decreased and on-task behavior increased post-intervention. Implications for practice and future research on interventions that target precursor behaviors are discussed.

Contexto: Pouco se sabe a respeito da prevalência e correlatos de autolesão deliberada em jovens de países em desenvolvimento. Além disso, existe uma escassez de estudos avaliando associações clínicas e com psicopatologia familiar ajustando-se para outras comorbidades, especialmente numa faixa etária mais jovem da população (dos 6 aos 14 anos). Objetivos: Nós investigamos a prevalência e as associações de autolesão deliberada em jo- vens desta faixa etária com fatores de risco demográficos (idade, gênero, status socioeconô- mico e etnicidade), clínico (diagnóstico psiquiátrico das crianças) e familiar (diagnóstico psiquiátrico materno) em um grande estudo comunitário no Brasil. Métodos: Participantes (n=2.508) e suas mães (n=2,295) da Coorte de Alto-Risco para Transtornos Psiquiátricos foram avaliados através da Development and Well Being Assess- ment (DAWBA) e Mini International Neuropsychiatric Interview (MINI) respectivamente. Autolesão atual (no último mês) e ao longo da vida foram estimadas, incluindo análises estratificadas por faixa etária. Regressões logísticas foram realizadas investigando o papel do diagnóstico clínico de crianças e adolescentes e da psicopatologia materna sobre as estimativas de autolesão, ajustando-se para potenciais fatores confundidores. Resultados: A prevalência de autolesão deliberada atual foi de 0,8% (0,6% para crianças e 1% para adolescentes) e ao longo da vida foi de 1,6% (1,8% e 1,5% respectivamente). Estas estimativas não variaram de acordo com a idade, sexo e etnicidade. No entanto, pertencer à classe média esteve associado a uma diminuição de 70% na probabilidade de se relatar um episódio de autolesão ao longo da vida comparando-se com a classe mais favorecida. Autolesão atual e ao longo da vida foram mais frequentes em jovens com Depressão Maior, Transtorno de Déficit de Atenção e Hiperatividade (TDAH) e Transtorno Opositor Desafiante (TOD), mesmo em modelos múltiplos ajustado para variáveis demográficas e co- ocorrência de transtornos psiquiátricos. Além disso, a presença de transtorno de ansiedade nas mães esteve fortemente associada com autolesão deliberada recente e ao longo da vida em seus descendentes. Ao estratificar-se a análise por faixa etária, esta associação tornou- se não significativa para crianças com autolesão recente e adolescentes com autolesão ao longo da vida; ao passo que, especificamente em crianças, autolesão recente foi associada com transtorno de humor materno. Conclusão: A autolesão deliberada é um problema importante em crianças e adolescen- tes. Os diagnósticos de Depressão Maior, TDAH e TOD estão consistentemente associados com este comportamento, bem como ter uma mãe com um transtorno de ansiedade. Nos- sos resultados salientam a importância de se perguntar a respeito de comportamentos suicidas em jovens com comportamentos disruptivos, independentemente da comorbidade com depressão, e também realçam a necessidade de estratégias preventivas com um en- volvimento familiar. / Background: Little is known about the prevalence and correlates of deliberate self-harm (DSH) in youngsters from low and middle-income countries. In addition, there is a shortage of studies evaluating clinical associations and family psychopathology adjusting for other comorbidities, especially in a younger age-group (from 6 to 14 years). Objectives: We investigated prevalence and associations of DSH in youngsters of that age range with demographic (age, gender, socioeconomic status and ethnicity), clinical (children psychiatric diagnosis) and familial risk factors (maternal psychiatric diagnosis) from a community-based study from Brazil. Methods: Participants (n=2,508) and their mothers (n=2,295) from the High Risk Co- hort for Psychiatric Disorders (HRC) were assessed through the Development andWell Be- ing Assessment (DAWBA) and the Mini International Neuropsychiatric Interview (MINI) respectively. Current (last month) and lifetime DSH were estimated, including analysis stratified by age-groups. Logistic regressions were performed investigating the role of youths’ clinical diagnoses and maternal psychopathology on prevalence estimates of DSH adjusting for potential confounding factors. Results: Prevalence of current DSH was 0.8% (0.6% for children and 1% for adolescents) and life-time DSH was 1.6% (1.8% and 1.5% respectively). These estimatives did not vary with age, gender and ethnicity. However, being from middle class was associated with a 70% decrease in the odds of reporting a lifetime episode of DSH comparing to the wealthiest class. Current and life-time DSH was more frequent in youth with Major Depression, Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD), even in multiple models accounting for demographic variables and co- occurring psychiatric disorders. Anxiety in mothers was strongly associated with current and life-time DSH in the offspring but when stratifying by age-group this association becomes non-significant for children with current DSH and for adolescents with lifetime DSH, whereas current DSH was associated with maternal mood disorder specifically in young children. Conclusion: Diagnoses of Major Depression, ADHD and ODD are consistently associated with DSH as well as having a mother with anxiety disorder. Our results emphasize the necessity to ask about suicidal behavior in young people with disruptive behaviors, regard- less of comorbidity with depression, and also highlight the need for preventive strategies with a family component.

The human intruder test (HIT) is a noninvasive tool widely used for assessing anxiety in rhesus macaques (Macaca mulatta). This thesis explores the HIT procedure and applies it to a population of monkeys with a self-injurious behavioral pathology. Individual variation on this test can be used to assess anxiety and temperament. The first experiment of this thesis applied two different procedures of the HIT to 17 monkeys at UMass. Monkeys displayed little response to the intruder, and no significant differences were detected for the two procedures. To determine whether these responses were unique to the UMass monkeys, their behavior was then compared to the behavior of monkeys at three other primate facilities. UMass monkeys showed less of a reaction compared to monkeys at other facilities. They came to the front of the cage when the intruder entered the room whereas the monkeys at other facilities moved to the back and showed virtually no threats to the intruder. One possible explanation is the increased exposure to humans that UMass monkeys experience. Even though the human running the HIT was a stranger, monkeys at UMass may not perceive a new human in front of their cage to be a threat. The second experiment tested the hypothesis that monkeys with a record of self-injurious behavior (SIB) would be more anxious in response to the HIT. The cage-side version of the HIT was applied to 41 monkeys with a record of self-injurious behavior and 36 matched controls. In contrast to our prediction, SIB subjects spent significantly less time showing anxious behavior and aggressive behavior toward the intruder as well as spent more time in the front of the cage. SIB subjects showed the same range of behaviors as controls, but significantly less behavioral change overall. These data add to the evidence from experiment one that the HIT may not be a sufficient novelty test to elicit a response in monkeys who are more often exposed to different people. An alternative explanation is that SIB is associated with a depressive like syndrome based on reduced overall activity and possibly lowered affect during the stare phase.

Prior research suggests a greater degree of suicidality and self-harm behavior in those involved with criminal justice and forensic mental health systems. Such individuals also evidence increased exposure to early childhood adversity, which is often associated with suicide risk. Other significant predictors of suicidality have been noted within forensic populations, however, including indicators of specific psychopathology and situational and demographic factors. These populations present with overlapping risk factors that remain underexamined. In the current study, 182 persons residing in secure forensic psychiatric care following incidents of illegal and aggressive behavior were evaluated. Adverse childhood experiences and other empirically derived potential predictors of suicide attempts and self-harm were examined via binomial logistic regression. Findings indicate frequent experiences of early adversity across participants, and that a combination of race, individual adverse childhood experiences, number of biological children, and diagnoses of either posttraumatic stress disorder or borderline personality disorder were significant predictors of suicide attempts, self-harm behavior, and first hospitalization resulting from a suicide attempt. Clinical and research implications are discussed.

The present study was designed to investigate the role of sensory extinction and sensory reinforcement in the moti- vation of self-injurious behavior. The intervention was based on the assumption that each subject's SIB behavior was motivated by the sensory consequences of the behavior. A pre- assessment phase was used to select appropriate sensory ex- tinction devices and sensory reinforcing toys, although no appropriate sensory toys could be identified. Thus, treat- ment consisted solely of sensory extinction using a reversal design. Results showed that the sensory extinction devices reduced tactile stimulation of face slapping and pica for two developmentally disabled adults. Maintenance of treat- ment gains was programmed by fading the device both on the unit and in the experimental setting. This procedure was minimally successful in achieving long term reduction in SIB.

Självskadebeteende är relativt vanligt förekommande bland personer med psykisk ohälsa. Återhämtning är ett begrepp som beskriver hur en person kan återerövra och finna kvalitet i sitt liv trots svår sjukdom. Självskadebeteende innebär ett stort lidande för individen och påverkar närstående i personens omgivning negativt. Syftet med denna litteraturstudie var att utifrån egenerfarnas perspektiv sammanställa kunskap om vad som främjar återhämtning vid självskadebeteende. Metoden för studien var en integrerad litteraturöversikt, vilken utgick från 15 vetenskapliga artiklar och resulterade i 6 kategorier. I resultatet framkom att återhämtning hos personer med självskadebeteende kunde främjas av att komma till en vändpunkt, att vara i gemenskap med andra med liknande erfarenheter, att få stöd av närstående, att få professionellt stöd, att förstå och kunna hantera svåra känslor och handlingar, och av att finna inre styrka. Forskning visade även att det bland vårdpersonal florerade negativa attityder och brister i förhållningssättet mot personer med självskadebeteende, vilket motverkade deras återhämtning. Vår slutsats är att etiska reflektioner i arbetsgruppen, handledning, stöd, samt utbildningsinsatser till vårdpersonal är angeläget för att öka förståelsen och höja kompetensen angående självskadebeteende; samt för att minska negativa attityder och förbättra omvårdnaden av personer med självskadebeteende på ett sätt som främjar deras återhämtning.

No description available.

Bakgrund: Självskadebeteende kopplas ofta ihop med psykiatriska tillstånd så som depression och ångestsyndrom och en vanlig uppfattning är att syftet med beteendet är suicidalt. Självskada används ofta som en strategi för att reglera negativa känslor. Patienter med självskadebeteende kan behöva insatser från olika nivåer och områden inom hälso- och sjukvården Det finns stigmatisering av patienter med självskadebeteende inom vården och samhället. Ett dåligt bemötande inom vården kan minska patientens självkänsla, tillit till vården samt leda till att patienten blir mindre benägen att söka vård i framtiden. Sjuksköterskan har en central roll i omvårdnaden av patienter med självskadebeteende, genom att lyssna, skapa sig förståelse samt identifiera behov. Syfte: ​​Syftet var att belysa sjuksköterskans erfarenheter vid omvårdnad av patienter med självskadebeteende.​ Metod: Metoden var en litteraturöversikt i enlighet med Fribergs metodbeskrivning. Sökningar genomfördes i databaserna Cinahl Complete och PubMed. Tio kvalitativa vetenskapliga originalartiklar valdes ut. Artiklarna analyserades ​för att identifiera likheter och skillnader. Resultat: ​Kunskap om självskadebeteende samt kommunikationsstrategier efterlystes av sjuksköterskor. Flera sjuksköterskor upplevde bristande förmåga att ge omvårdnad till patienter med självskadebeteenden. Vårdrelationen lyftes som central i omvårdnaden av denna patientgrupp och sjuksköterskans bemötande. Förmågan att lyssna och få patienten att känna sig hörd ingick i sjuksköterskornas omvårdnadsarbete. Ytterligare aspekter av omvårdnaden var sjuksköterskans attityder och dessa ansågs kunna ändras med hjälp av ökad kunskap. Resultatet visade även att en del i omvårdnaden av patienter med självskadebeteende var att hindra patienten från att självskada, sköta om fysiska skador samt att göra olika typer av riskbedömningar. Omvårdnaden inom akutmiljöer beskrevs som utmanande då ett stort fokus låg på snabb somatisk vård samt att det var svårt att förse patienterna med en lugn miljö. Slutsats: ​​Det finns en osäkerhet hos sjuksköterskor kring vårdandet av patienter med självskadebeteende och mer kunskap efterfrågas. Den akuta vårdmiljöns brist på tid och resurser försvårar omvårdnaden av patienter med självskadebeteende. Vårdrelationen och kommunikationen mellan sjuksköterska och patient är centralt för en personcentrerad omvårdnad. Sjuksköterskor anser även att en viktig aspekt av omvårdnaden är bemötande och attityder där ett empatiskt, icke dömande och in lyssnande förhållningssätt är fördelaktigt. / Background: Self-injurious behavior is often linked with psychiatric conditions such as depression and a common perception is that the aim is suicide. Self-injury is often used as a strategy to regulate negative emotions. People with self-harming behavior may need interventions from different levels and areas within the health care system. There is stigmatization of patients with self-harming behavior, both within healthcare and society. Poor treatment in care can reduce the patient's self-esteem, trust in care and lead to the patient being less inclined to seek care in the future. The nurse has a central role in the care of patients with self-harming behavior, by listening, understanding and identifying needs. Aim: Nurses experiences of caring for patients with self-injurious behaviour Method: ​​The method used was a literature review following Friberg‘s methodological framework. Searches were conducted in the databases Cinahl Complete and PubMed. Ten qualitative original scientific articles were selected. The articles were analyzed  to identify similarities and differences.​ Results: Knowledge of self-injurious behavior and communication strategies were requested by nurses. Several nurses experienced a lack of ability to provide nursing care to patients with self-harming behaviors. The nursing relationship was highlighted as central in the care of this patient group, and the nurse's approach, ability to listen, and making the patient feel heard were integral aspects of nursing care. Other aspects of nursing care included nurse's attitudes, which were believed to be changeable through increased knowledge. The results also showed that an important part of the nursing care of patients with self-harming behavior was to prevent the patient from self-harming, caring for physical injuries and making different types of risk assessments. Nursing care in emergency settings was described as challenging as there was a large focus on rapid somatic care and it was difficult to provide patients with a calm environment.​ Conclusions: ​​Nurses express uncertanty regarding the care of patients with self- harming behavior and there is a demand for increased knowledge. The lack of time and resources in emergency departments complicates the care for patients with self-injurious behavior. The relationship and communication between the nurse and patient is central to person-centered care. Nurses also believe that a crucial aspect of care involves attitudes approaches, emphasizing the importance an empathic, non- judgemental and attentive demeanor.