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