Depression and self-harm are major public health concerns in teenagers, with at least 10% of teenagers in developed countries reporting self-harm by the age of 16 years. The rates of emotional problems in adolescence might also be increasing.
Many factors could be associated with emotional problems in this age group, including subculture identification. In ‘The Lancet Psychiatry’, Lucy Bowes and colleagues used data from a United Kingdom community-based birth cohort (the Avon Longitudinal Study of Parents and Children [ALSPAC]) to investigate whether the emergence of depression and self-harm at 18 years is associated with self-identification as a goth at the age of 15 years (3964 individuals included in analysis).
This study has many strengths but is particularly noteworthy because the investigators extended previous research on this topic by controlling for key potential confounders, including baseline self-harm, early emotional and behavioural difficulties, and psychiatric disorder. Consistent with other similar studies, Bowes and colleagues identified an association between goth self-identification and self-harm.
Not only did they find the predicted association (unadjusted odds ratio [OR] increased by 1·36 (95% CI 1·23–1·49) for depression and 1·52 (1·42–1·63) for self-harm for each unit increase in goth affiliation), but they also reported a dose-response association between goth identification and future self-harm and depression.
Individuals who identified very much with being a goth were three times more likely to score within the clinical range for depression with the Clinical Interview Schedule at 18 years compared with those who did not identify as a goth (unadjusted OR 3·67, 2·33–4·79).
A few potential limitations, which the authors also note, are important to mention. Although the investigators used multiple imputation techniques to manage the missing data, a substantial number of participants were lost to follow-up (only 2351 (43%) adolescents in the eligible cohort of 5515 were used to investigate the main and independent effects).
This ought to be borne in mind when considering the generalisability of the findings. In particular, those who participated at the age of 18 years came from families of higher social class and higher levels of education compared with the original ALSPAC study sample. Future research should investigate the strength of the association between goth identification and emotional problems in more disadvantaged populations.
Similar to other studies of this kind, the possible effects of residual confounding are impossible to rule out, although the authors have adjusted for many of the likely candidates in their analyses. Taken as a whole, therefore, the findings suggest that adolescents who identify with the goth subculture could be at an increased risk of depression and self-harm.
Needless to say, because this is an observational study, these findings do not provide evidence for causality. However, several possible pathways might explain the increased susceptibility to depression and self-harm. Social selection might account for the association (i.e., those who are similar seek out the company of like-minded individuals), as has been suggested for suicide. Social transmission, in the form of social contagion, might also be important, in the self-harm association in particular.
Information about exposure to self-harm in others was not reported in the study by Bowes and colleagues. However, because previous research has shown that emulation of peer suicidal behaviour is related to increased risk of suicide in adolescents, further examinations of this in adolescents who identify with the goth subculture would be interesting. Additionally, the experience of similar stressors linked to goth self-identification (e.g., victimisation) might increase the susceptibility of members of this subculture to depression and self-harm.
In their study, Bowes and colleagues investigated young people’s identification with differently named peer groups (e.g., goths, skaters), but they did not ask about peer identification more generally. Therefore, the identification with the specific peer group (e.g., goth) rather than overall peer identification might be essential and would be interesting to investigate.
Future research should also directly investigate the role of social norms (i.e., common beliefs and behaviour associated with a particular group) associated with specific peer groups in this context. A previous study of adults reported that intention to self-harm was higher in those who strongly identified with a peer group in which self-harm was part of the social norm than in those who did not.
In all probability, however, several mechanisms will be needed to explain the apparent increased risk of emotional problems in this subgroup of adolescents.
Another issue is that if goth self-identification is associated with emotional issues at 18 years of age, how long do these effects last? This question could not be addressed by Bowes and colleagues’ study, but it would be useful to investigate this in future research. Also, in view of the fact that not all goths were rated as being within the clinical range for depression or reported self-harm at 18 years of age, identification of protective factors would be useful. Further research should investigate whether goth identification is similarly associated with suicidal versus non-suicidal self-harm.
Bowes and colleagues’ findings hold important implications for clinical practice. Clinicians working with adolescents showing an interest in the goth subculture and displaying signs of goth identification should be aware of the increased risk of depression and self-harm in later adolescence.
Further monitoring and assessment of self-harm risk is recommended for these young people. It is, however, important to determine whether adolescents identifying with goth subculture seek professional help for emotional problems and whether they have different help-seeking attitudes compared with adolescents who identify with other cultures.
If adolescents identifying as goths seek less professional help and have different attitudes, this finding will have important implications for the management of risk of depression and self-harm in this vulnerable group.