Gonneke W.J.M.Stevens; Wilma A.M.Vollebergh; Trees V.M.Pels

Sco Psychiatry Psychiar Epidemiol(2005) 40: 571-579

Impact factor: 2.052

Date:99/10/14

Introduction◦ Externalizing◦ Internalizing

Methods

Result

Discussion

Conclusion

This aim of the current study is to contribute to the knowledge in this field◦ Externalizing problems◦ Internalizing problems

Child factor◦ Internalizing

According to Zahn-Waxler et al. , the strongest risk factor for emotional Problems is gender: Female adolescents were found to be at least twice as likely as males to become anxious and depressed, a pattern that continues throughout adulthood

◦ Externalizing Associations between child variables and externalizing behavior

are well established in literature

Family factor◦ Internalizing

Several processes in, and characteristics of, the family influence the development of emotional problems in adolescents

◦ Externalizing Parental behavior in interaction with the child is the family

factor most proximal to the child’s everyday experience

School/peer factor ◦ Internalizing

Although parents still occupy a central position in the lives of their children, relations with peers become increasingly important during adolescence

◦ Externalizing The child’s progress into adolescence is marked by increased

involvement with peers. In this period, parental influence diminishes whereas peer influence increases

Migration factor◦ Internalizing

Moroccan adolescents may be faced with risk factors related to their (or their parents‘) migration

◦ Externalizing Variables specific for migration, like country of birth and fluency

in the language used in the current country may influence the level of externalizing problems in Moroccan immigrant adolescents

Three goals- Externalizing◦ First: Gain insight into the predictors of externalizing problems

in Moroccan immigrant adolescents living in the Netherlands in the age range of 11-18 years

◦ Second: The gender specificity of the associations is examined

◦ Third: Want to find out which factor is most strongly associated with externalizing problems in Moroccan immigrant adolescents

Three goals-Internalizing ◦ First: Gain insight into the predictors of internalizing problems in

Moroccan immigrant adolescents living in the Netherlands in the Netherlands

◦ Second: Examine the gender specificity of the associations

◦ Third: Examine the contribution of child, proximal family, parent, contextual family, global family, school/peer, and migration factors to the prediction of emotional problems with and without controlling for the other predictor sets

Sample

PopulationPopulationAged 4 through 8 Aged 4 through 8

At least one parent born in Morocco of two At least one parent born in Morocco of two of the four largest cities in Netherlandsof the four largest cities in Netherlands

N=1260N=1260

N=1127N=1127

For 73%For 73%N=819N=819

Parent reportParent reportN=415N=415

teacher reportteacher reportN=296N=296

Adolescents reportAdolescents reportAged 11 through 18Aged 11 through 18

N=376N=376

Response rate 82%Response rate 82%N=238N=238

excluded 7excluded 7

April 2000 to July 2002April 2000 to July 2002

Permission for parents and adolescents

Only one child Only one child per familyper family

Excluded 96Excluded 96

Mentally retardedMentally retardedLived in MoroccanLived in Moroccan

Excluded 37Excluded 37

Sample

Instruments ◦ Internalizing and externalizing behavior

Child Behavior Checklist (CBCL) Youth Self-Report (YSR) Teacher’s Report Form (TRF) Internalizing

Sum of scores on items in the Withdraws, Somatic Complaints, and Anxious/Depressed syndrome profiles

Externalizing Sum of scores on the Delinquent and Aggressive behavior

syndromes

Instruments ◦ Child factor

Gender Age Internalizing Chronic health problems of the child were obtained from the

parent

Instruments ◦ Proximal family factor

Affection 0=highly disagree to 5=highly agree

Monitoring 0=nothing to 3=everything

Support from father (α=0.86) Support from mother (α=0.78) Parent-child conflict (parent report α=0.90) Parent-child conflict (adolescent report α=0.85)

0=never to 4=very often

Instruments ◦ Parent factor

Somatic symptoms Anxiety/Insomnia (α=0.90) Social Dysfunction (α=0.77) Severe Depression

Instruments ◦ Contextual family factor

Conflicts parents about parenting Conflicts parents about other things

0=never to 2=often Positive communication parents Destructive communication parents Total number of life-events

Instruments ◦ Global family factor

Marital status 0=married 1=not married

Family education level 0=no education at all to 4=high level of vocational training or

university Family employment level

0=no job to 3=high job level Number of children in the family

Instruments ◦ School/peer factor

Problems at school Being bored

0=never to 4=each day Support from friends (α=0.86) Deviant peers

0=no; 1=yes (α=0.86) Hanging out

0=never to 4=each day

Instruments ◦ Migration factor

Country of birth adolescent Muslim identification adolescent (α=0.76) Perceived group discrimination adolescent Muslim identification parent (α=0.59) Perceived group discrimination parent Fluency in Dutch parent (understanding) Fluency in Dutch parent (speaking)

0=not all to 3=very well

Statistical analysis◦ Cross-sectional study◦ Univariate analysis◦ Linear regression analysis◦ Cronbach's alpha

Externalizing problems

Internalizing problems

Externalizing problems

Internalizing problems

Internalizing problems

internalizing Externalizing

Gender Gender

externalizing Internalizing

Parent-child conflict (parent report) Affection

Conflicts parents about parenting Monitoring

Perceived group discrimination adolescent Support from father

Support from mother

Parent-child conflict (parent report)

Problems at school

Deviant peers

Hanging out

Study limitations◦ Unable to examine the causal directions of the associations

◦ Unable to test whether the associations about externalizing or internalizing problems between Moroccan immigrant and Western populations

◦ Not all important predictors have been taken into account temperament for externalizing and internalizing

Study limitations◦ Sample might not be representative for the entire Moroccan

immigrant population in Netherlands Almost 50% of the Moroccans

◦ Unable generalized to other migrant populations, as differences between migrant populations are numerous

Study suggest that the child, school/peer, and proximal family factors are essential in models predicting the development of externalizing and internalizing problems turned out to be relatively small