Goth teens 'at increased risk of depression and self-harm'

10:23am Friday 28th August 2015

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"Goths are three times more likely to be depressed than other teenagers, with 37% admitting to self-harming," the Daily Mail reports. 

A new study looked at mental health outcomes in young people who said they identified with the goth sub-culture. Goths favour black clothes, stark make-up, gloomy music and an interest in the darker side of life.

The study involved 2,000 teens and looked at whether self-identification as a goth at age 15 is linked to depression and self-harm at 18. 

After full adjustment for prior mental health and behavioural problems in the child, the study found goths were around a quarter more likely to have depression by 18 and a third more likely to report self-harming.

The obvious question is, does being a goth make you prone to depression, or are people already prone to depression more likely to identify with goth culture?

It's likely the relationship between mental health and self-identity is a complex one that cannot be boiled down to a simple "X leads to Y" statement.

And it could even be the case that for some teens who would otherwise have remained socially isolated, adopting the goth sub-culture brings a sense of peer solidarity.

Nevertheless, the study still indicates that those who identify with goth culture may be a group with an increased risk of mental health problems. Providing support to these young people could be beneficial.  

A short history of goth

Goth grew out of the UK post-punk scene of the late 70s and early 80s. Early pioneers of the goth sound included Siouxsie and the Banshees, and Bauhaus.

 

Like most youth sub-cultures, it soon evolved into varying different "strains", ranging from emo and industrial, to death metal.

 

But whatever they call themselves, most are fond of dark clothes, monochromatic make-up, and a fascination with the morbid and sinister.

Where did the story come from?

The study was carried out by researchers from the University of Oxford and other academic institutions in the UK. 

It was funded by the Wellcome Trust and the Medical Research Council Programme, and was published in the peer-reviewed Lancet Psychiatry on an open access basis, so it can be read for free online.

The UK media's reporting of this well-conducted research is generally accurate. But an exception to this is The Daily Telegraph, which carried the headline: "Chavs are less depressed than goths, Oxford University finds". This is unsupported by the evidence provided by the study. Rates of depression and self-harm in this group are not given in the paper. 

What kind of research was this?

This cohort study aimed to look at the association between teen self-identification as a goth and depression and self-harm.

Previous research observed that deliberate self-harm is associated with goth culture in young people. However, it is unclear whether this is a direct causative association or whether this link is being influenced by other factors - for example, family, peer or life circumstances.

The researchers aimed to try to look at the direction of effect by assessing self-identity at 15 years and then look for the emergence of new mental health problems at 18 years. 

What did the research involve?

This study involved children enrolled into the Avon Longitudinal Study of Parents and Children (ALSPAC). This is an ongoing study that recruited pregnant women in Avon due to have a baby between April 1991 and December 1992. All children in this study have been invited to attend follow-up assessments every year since the age of seven.

This study included those who took a computer-based survey at the assessment at the age of 15, which asked them to self-identify as one of eight different social groups: sporty, populars, skaters, chavs, loners, keeners, bimbos, and goths.

They were asked further questions about how much they identified with these categories. For example, "Is there a group of teens in your school or neighbourhood with the reputation of rebelling against the norm (in clothing or ideas, for example), or in attempting not to conform to social ideals (e.g. goths)?" and "How much do you identify with the goths?" - to which they answered "not at all", "not very much", "somewhat", "more than somewhat", or "very much".

At the same time they also completed the Development and Wellbeing Assessment, which includes questions about symptoms of depression and self-harm.

Then, at the age of 18, depression was assessed using the Clinical Interview Schedule-Revised (CIS-R), where diagnoses are made according to standard diagnostic criteria from the International Classification of Diseases (ICD). 

This scale also assessed self-harm with questions such as, "Have you ever hurt yourself on purpose in any way (e.g. by taking an overdose of pills or by cutting yourself)?". The researchers didn't make a distinction between whether or not self-harm was associated with suicidal intent.

The researchers looked at the association between goth identification and depression or self-harm at 18 years, adjusting for these factors at 15 years to try to better determine a causative direction of effect. 

They further adjusted their analyses for various individual, family and social characteristics, making use of earlier ALSPAC assessments. This included the mother's history of depression, temperament and educational attainment, as well as the child's earlier history of depression, emotional or behavioural problems, or bullying. 

What were the basic results?

Overall, full data on self-identification and mental health at 15 and 18 years was available for 2,351 teens, who formed the sample for this analysis. This represented just under half of the potential ALSPAC cohort who were still participating in the assessments at 15 years.

Those identifying as goths were more likely to be girls, to have mothers with a history of depression, to have reported being bullied as a child, and to have a history of depression or emotional or behavioural problems themselves.

Depression at 18 years was associated with the extent they identified with goth culture. For example, the depression rate among those who did not identify at all was 6%, compared with 9% of those who identified "somewhat" and 18% of those who identified "very much". After adjustment for confounders, people who identified as a goth were 27% more likely to have depression at 18 years (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.11 to 1.47). The confounder having the greatest influence was previous depression in the teen/child themselves.

There was also a similar link between goth identification and self-harm, with the greater the extent of identification being associated with the highest risk. 

After adjustment for confounders, goths were a third more likely to report self-harm at 18 years (OR 1.33, 95% CI 1.19 to 1.48). A total of 37% of those who "very much" identified as a goth had self-harmed by 18.

As a comparison, for those who identified "very much" with other groups:

How did the researchers interpret the results?

The researchers concluded that, "Our findings suggest that young people identifying with goth sub-culture might be at an increased risk for depression and self-harm."

They go on to say that, "Working with young people in the goth community to identify those at increased risk of depression and self-harm and provide support might be effective." 

Conclusion

This cohort study has found positive links between self-identification as a goth at 15 years, and subsequent depression and self-harm at 18 years.

The study has many strengths, including the use of a large ongoing cohort study, which has carried out regular annual assessments of the mother and child. This has allowed the researchers to adjust their analyses for prior history of mother and child mental health and behavioural problems.

The study also used recognised assessment scales throughout, which has allowed the researchers to make valid clinical diagnoses of mental health problems.

However, the main point is as the researchers rightly say: "Our observational findings cannot be used to claim that becoming a goth increases risk of self-harm or depression". 

The study has made a valid attempt to explore the possible direction of effect by seeing whether identifying as a goth at 15 precedes depression and self-harm at 18 years.

But this still can't prove cause and effect. You can't say, for example, that if this individual hadn't become immersed in goth culture, they would never have developed depression or self-harm behaviours by 18 years.

It could still be the case that personality characteristics, family or peer relationships, or life circumstances may make the teen more likely to be drawn to the goth culture, but may also separately make them more predisposed to depression or other mental health problems.

The self-identification categories on the survey are also quite vague. Even though the researchers made clear attempts to explore the extent the individual identifies with a particular category, each category is still likely to have captured a wide range of personality characteristics and behaviours.

Self-identification is highly subjective, and two people who identify themselves as a goth "very much" may be quite different. It is possible that teens may not have identified particularly with any of these categories and were just having to opt for the one that seemed to be the best fit.

It is also not known how sincerely teens may have responded - for example, people may have called themselves a "chav" or a "bimbo" only lightheartedly.

And although the research and media attention has focused on goths, the findings suggest other groups, such as "skaters" and "loners", may also be vulnerable young people.

Overall, this research cannot prove direct causation, but it still indicates that those identifying with the goth culture may be a group with an increased risk of mental health problems. As the researchers suggest, providing support to these young people could be beneficial. 

Those who may be well placed to recognise young people who may be having emotional or behavioural difficulties - goths or otherwise - include family members and other peers, schools, and youth groups. 

Depression can potentially affect all teens, whether they are goths, Directioners (especially since the One Direction break-up), chavs or sporties. Read more about the possible signs of depression in young people.

Summary

"Goths are three times more likely to be depressed than other teenagers, with 37% admitting to self-harming," the Daily Mail reports. A new study looked at mental health outcomes in young people who said they identified with the goth sub-culture.

Links to Headlines

Goths are THREE times more likely to be depressed than other teenagers, with 37% admitting to self-harming. Daily Mail, August 28 2015

Chavs are less depressed than goths, Oxford University finds. The Daily Telegraph, August 28 2015

Goth teenagers at higher risk of depression, study suggests. The Guardian, August 28 2015

Young goths 'at risk of depression'. BBC News, August 28 2015

Goths at risk of depression or self-harming, research says. The Independent, August 28 2015

Links to Science

Bowes L, Carnegie R, Pearson R, et al. Risk of depression and self-harm in teenagers identifying with goth subculture: a longitudinal cohort study. The Lancet Psychiatry. Published online August 27 2015

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