Internalising Symptoms Research Articles

Gender non-conformity in childhood and adolescence and mental health through to adulthood: a longitudinal cohort study, 1995-2018.

Few studies have examined associations between gender non-conformity (GNC) in childhood or adolescence and mental health outcomes later in life. This study examined associations between (1) GNC and mental health over multiple time points in childhood and adolescence, and (2) GNC in childhood and/or adolescence and mental health in adulthood. Second generation participants from the Raine Study, a longitudinal cohort from Perth, Western Australia. Data were collected between 1995 and 2018, comprising seven waves: ages 5 (N = 2236), 8 (N = 2140), 10 (N = 2048), 14 (N = 1864), 17 (N = 1726), 22 (N = 1236) and 27 (N = 1190) years. History of GNC, v. absence of this history, was based on responses to item 110 from the Child Behaviour Checklist (CBCL)/Youth Self Report (YSR) ('wishes to be of opposite sex'). The CBCL/YSR were used to measure internalising and externalising symptoms. Items 18 ('deliberate self-harm [DSH] or attempts suicide') and 91 ('talks/thinks about killing self') were used as measures of suicidal ideation (SI) and DSH. For adults, Depression, Anxiety and Stress Subscales and Kessler Psychological Distress Scale assessed mental health. Child and adolescent GNC was associated with elevated internalising and externalising behaviours and increased odds of DSH. A history of GNC was also associated with vulnerability for severe psychological distress in adulthood in some symptom scales. GNC over the child and adolescent period is associated with significant emotional and behavioural difficulties, and psychological distress. A history of GNC in childhood and/or adolescence also predicts poorer mental health in adulthood on multiple symptom domains.

Poor written pragmatic skills are associated with internalising symptoms in childhood: evidence from a UK birth cohort study

IntroductionThis study examined the relation between pragmatic language and internalising (depressive and anxiety) symptoms in 11-year-olds, using data from the 1958 British birth cohort study.MethodsThe cohort children were asked at age 11 to write an essay on their life as they imagined it would be at age 25. We analysed 200 of these essays for relevance, organisation and context-dependent references.ResultsWe found associations between these aspects of pragmatic language and children's internalising symptom scores across parent and teacher ratings, even after adjustment for cognitive ability, socioeconomic position and structural language. Most notably, children writing more coherent essays had fewer teacher-rated internalising symptoms, after adjustment for confounders. Additionally, children who provided more relevant and varied information about their imagined future home-lives had fewer parent-rated internalising symptoms, after adjustment for confounders.DiscussionThe unique associations between pragmatic language skills and internalising symptoms observed are notable but preliminary, highlighting both the need for further research and potential applications for risk-assessment tools.

Psychosocial dysfunction of children and adolescents during the COVID-19 lockdown in Ecuador: a cross-sectional study

ObjectiveAlthough the risk of morbidity and mortality of children and adolescents was lower during the COVID-19 pandemic, it appears that their mental health was strongly impacted. The goal of this...

Moderating Effects of Student Engagement on the Relationship Between Weight Bias Internalization and Depressive Symptoms Among Adolescent Girls With Higher Weight

This study aimed to examine the moderating effect of student engagement between weight bias internalization and depressive symptoms in Korean adolescent girls with higher weight. Ninety-nine girls with higher weight (≥85th body mass index percentile) in early adolescence (aged 12–14 years) participated in this cross-sectional study. Weight bias internalization, student engagement, and the interaction between these variables were significantly associated with depressive symptoms. Furthermore, a simple slope analysis indicates that higher student engagement was associated with more significant relief in depressive symptoms. Thus, promoting higher student engagement with family and school support may help reduce depressive symptoms related to weight bias internalization in adolescent girls with higher weight. Therefore, family- and school-based programs are required to enhance student engagement in adolescent girls with higher weight.

Development and initial validation of a short form of the Memories of Home and Family Scale

BackgroundThe Memories of Home and Family Scale (MHFS; Shevlin et al., 2022) was developed as a multidimensional measure of subjective memories of experiences at home and with family during childhood. Due to the length of the scale, a short version of the MHFS (MHFS-SF) has been developed. Data were from Wave 7 of the COVID-19 Psychological Research Consortium Study (C19PRC-UK), a population based UK survey (N = 1405). Two items with the highest factor loadings from each of the six dimensions of the original MHFS were selected for inclusion. Confirmatory factor analytic (CFA) models were estimated to test the dimensionality of the scale. Convergent and discriminant validity were tested by examining associations with criterion variables. CFA results supported the multidimensionality of the scale. MHFS-SF total and sub-scale scores were negatively correlated with measures of depression, anxiety, loneliness, and paranoia, and were positively correlated with wellbeing. Regression analyses revealed that MHFS-SF total and sub-scale scores significantly predicted loneliness, paranoia, and wellbeing, even after accounting for age, gender, and current internalising symptoms. Results from this study suggest that the MHFS-SF scores retain the excellent psychometric properties of the original scale while improving efficiency. The MHFS-SF demonstrated high levels of convergent and discriminant validity with mental health and wellbeing measures. Future research should seek to validate the MHFS-SF in different populations and assess its usefulness in clinical settings.

Secondary data analysis of social care records to examine theprovision of mental health support for young people in care.

Young people in care are much more likely to experience mental health difficulties than the general population, yet little is known about the provision of mental health support for this group in the United Kingdom. Using routinely collected social care data, we explored the provision of mental health support for 112 young people in care in the UK. We identified young people experiencing elevated internalising or externalising difficulties in their first year in care (based on strengths and difficulties questionnaire scores) and extracted data on mental health referrals and provision. We generated descriptive statistics relating to provision of mental health support and used regressions to examine predictors of mental health provision, and associations between support and mental health outcomes one and 2years later. Eighty-one percent of the children (n=79) were referred to mental health services in their first year of being in care. Referrals were usually for emotional or conduct problems. Those with higher externalising symptoms were more likely to be referred than those with higher internalising symptoms (OR=1.2, (95% confidence interval (CI): 1.01, 1.38)). Females were more likely to access support than males (OR=3.82 (95% CI: 1.2, 13.3)). Sixty-eight percent of children (n=66) accessed mental health services in their first year of being in care. Of those who accessed services, support ended prematurely for 29 (44%) of them, often due to placement instability or disengagement. Accessing support in the first year of care was not associated with changes in mental health 1year (OR: 2.14 (95% CI: 0.62,7.29)), or 2years after entering care (OR: 0.72-8.57, (95% CI: 0.72, 8.57)), although methodological limitations are noted. Mental health difficulties for children in care are recognised quickly, but mental health support may be difficult to access, with issues evident in retention and engagement.

Racialised identity, racism and the mental health of children and adolescents

As a social justice issue, it is suggested that racialised identity may represent a critical moderator in the association between racism and adverse mental health. We performed a meta-moderation analysis of studies on racialised identity, racism and adverse mental health in children and adolescents. We searched Pubmed, Web of Science, SocINDEX, PsychInfo, Medline, CINAHL and EBSCO Academic Search Ultimate for peer-reviewed articles published between January 2013 and December 2022. Nine studies, encompassing 2146 Black, Moroccan, Turkish, Indigenous, South Korean, Latinx and Multi-heritage children and adolescents between the ages of 7 and 16, were included, covering depressive symptoms, substance use, internalising symptoms and externalising symptoms. A random effect meta-analysis reported a medium size positive correlation of 0.26 (95% CI = 0.20–0.32) between racism and adverse mental health. A comparison between internalising and externalising symptoms revealed a smaller positive correlation of 0.25 (95% CI = 0.09–0.41) for internalising symptoms and a slightly larger positive correlation of 0.30 (95% CI = 0.19–0.41) for externalising symptoms. A small negative moderation of −0.07 (95% CI = −0.17 to 0.02) was found for racialised identity in the association between racism and internalising symptoms, whilst no moderation was found between racism and externalising symptoms. Overall, a negligible moderation of −0.02 (95% CI = −0.08–0.05) was found for racialised identity in the association of racism to adverse mental health. These findings suggest that the effect of racism on internalising symptoms is slightly stronger for children and adolescents with lower racialised identities and slightly weaker for those with higher racialised identities.

Psychometric Properties of the Cognitive Emotion Regulation Questionnaire and Shortened Versions in Dutch Speaking Community-Dwelling Older Adults

Most studies on the psychometric properties of the Cognitive Emotion Regulation Questionnaire (CERQ) were done in adolescents and adults. The scarce studies in older adults were mainly limited to associations of CERQ scales with internalising symptoms and wellbeing. Only one study explored the underlying factor structure in Spanish older adults and concluded that only a 27 item CERQ version showed adequate fit when tested with confirmatory factor analysis. The present study analyses the psychometric properties of all three versions of the CERQ in a sample of 451 community-dwelling older adults: the original 36 item CERQ, the short 18 item CERQ developed by the original authors and a Spanish 27 item CERQ version. Because gender differences among strategies used have been reported, the present study examined and provided first evidence for the gender invariance of the CERQ structure. Moreover, cognitive emotion regulation strategies correlated like hypothesized with clinical symptoms in general, and behavioural inhibition and activation systems and coping styles. The nomological net was highly similar for the original CERQ and shortened versions. The shortened versions of the CERQ consequently can be viable alternatives to the CERQ in settings where short assessment instruments are needed.

Drinking to Cope is Uniquely Associated with Less Specific and Bleaker Future Goal Generation in Young Hazardous Drinkers

Groups with mental health and/or substance use problems generate less detailed descriptions of their future goals. As substance use to cope with negative affect is common to both groups, this characteristic might be uniquely associated with less specific goal descriptions. To test this prediction, 229 past year hazardous drinking undergraduates aged 18–25 years wrote about three positive future life goals in an open-ended survey, before reporting their internalizing (anxiety and depression) symptoms, alcohol dependence severity and motivations for drinking: coping, conformity, enhancement and social. Future goal descriptions were experimenter-rated for detail specificity, and participant-self-rated for positivity, vividness, achievability, and importance. Effort in goal writing was indexed by time spent writing and total word count. Multiple regression analyses revealed that drinking to cope was uniquely associated with the production of less detailed goals, and lower self-rated positivity and vividness of goals (achievability and importance were also marginally lower), over and above internalizing symptoms, alcohol dependence severity, drinking for conformity, enhancement and social motives, age, and gender. However, drinking to cope was not uniquely associated with reduced effort in writing goals: time spent and word count. In sum, drinking to cope with negative affect is a unique characteristic predicting the generation of less detailed and bleaker (less positive and vivid) future goals, and this is not due to lower effort in reporting. Future goal generation may play a role in the aetiology of comorbidity of mental health and substance use problems, and therapeutic targeting of goal generation might benefit both conditions.

Investigating the factorial structure and measurement invariance of the parent-reported strengths and difficulties questionnaire at 11years of age from the UK Millennium Cohort Study.

The strengths and difficulties questionnaire (SDQ) consist of five sub-scales that have been used to measure internalising and externalising symptoms in children, typically by combining sum scores of two sub-scales each, and pro-social behaviours. However, the different possible factorial structures that represent these symptoms have not been formally tested in a nationally representative sample of UK children. In addition, it is necessary to assess whether the SDQ is interpreted similarly across subgroups of the population. Exploratory and confirmatory factor analysis were used to test three competing structures for the parent-reported SDQ collected at age 11, the start of adolescence, in the UK Millennium Cohort Study (n = 11,519), and measurement invariance was assessed according to sex and a measure of deprivation of the area in which households lived. Internal consistency using ordinal alpha, internal convergent validity and external discriminant validity using average variance explained (AVE), and predictive validity were assessed. A five-factor model and a model with two second-order factors for internalising and externalising symptoms had better model fit than a three-factor model. For both structures, invariance was demonstrated across sex and area-level deprivation. AVE scores for the five-factor model indicated that peer and emotional problems factors were measuring a similar construct, as were the hyperactivity and conduct factors. In the second-order model, AVE scores indicated internalising and externalising symptoms were distinct constructs. A second-order model with two factors for internalising and externalising symptoms is appropriate for use in a cohort of UK children born in 2001/02, and our finding of invariance across sex and area-level deprivation indicate that the SDQ can be used in analysis investigating differences in symptoms across subgroups of the population.

Longitudinal patterns of childhood homelessness and early adolescent trajectories of internalising and externalising behaviour

BackgroundChild homelessness has been associated with elevated mental health problems during early adolescence, a period of onset for psychiatric problems. Prior literature has relied on cross-sectional studies, limiting the understanding...

Examining coping and acculturative stress as mediators between perceived discrimination and internalising symptoms among African immigrants

AbstractThis study examined whether avoidant coping behaviours and acculturative stress functioned as mechanisms linking perceived discrimination to internalising mental health symptoms among African immigrants living in the United States. We used cross‐sectional data collected between December 2019 and January 2020 from US‐based first and second‐generation African immigrants (N = 599, 50% first‐generation, 82% Black, 71% female, mean age = 30). Path modelling was performed to examine the mediating role of avoidant coping and acculturative stress on the relationship between perceived discrimination and internalising symptoms. Results showed that perceived discrimination was related to internalising symptoms via avoidant coping and acculturative stress (specifically social and environmental stress). These results provide support that coping strategies and acculturative stress are likely important micro‐level mechanisms by which the discrimination‐mental health association persists. Implications and recommendations for prevention and intervention to reduce negative impacts of perceived discrimination on immigrant mental health are discussed.

Caregiver Worry of Infection and Family Co-existence Difficulty and Association With Change in Children's Internalizing and Externalizing Symptoms During the Initial COVID-19 Lockdown in the UK and Turkey.

The study examined whether caregiver worry of COVID-19 infection and co-existence difficulty differentially predicted child mental health and wellbeing during the lockdown in two culturally different countries that were severely affected by the pandemic: the UK and Turkey. Co-existence difficulty is the hardship experienced by family members living all together in the same house at the same time during the lockdown period. Participants were 1849 caregivers of children between 5- and 12-years old living in the UK (n = 995) and Turkey (n = 854), who completed an electronic survey distributed via social networks during the initial phase of the COVID-19 lockdown (July and August 2020). Caregivers completed a set of questionnaires on child and family wellbeing and on whether the child's internalizing and externalizing symptoms changed during the lockdown as compared to before. Worry of COVID-19 infection was higher amongst caregivers in the Turkish sample and was associated with higher levels of child internalizing symptoms during the lockdown in the Turkish sample, however there were no statistically significant differences in the size of the impact of worry of infection on the children's internalizing symptoms between the two countries. Co-existence difficulty independently predicted increase in children's internalizing and externalizing symptoms during the lockdown in both samples. Families in the UK experienced a higher level of difficulty with co-existence compared to the families living in Turkey but the magnitude of the impact of co-existence difficulty on children's outcomes between the two samples was not significantly different.The findings suggest that public health strategies should aim to reduce social anxiety and invest in the development of programs aimed at supporting families to overcome the challenges of co-existence during times of public health crisis.

A systematic review of non-specific and specific treatment factors associated with lower or greater internalising and externalising symptoms in therapeutic residential care

BackgroundThere is limited evidence on how Therapeutic Residential Care (TRC) achieves treatment goals: TRC remains too much of a “black box”. We need to know more about how results are achieved, rather than merely investigating the achieved results. ObjectiveThis systematic review aimed to synthesize quantitative literature regarding the associations between non-specific and specific treatment factors and lower or greater internalising and externalising symptoms. MethodFollowing PRISMA guidelines, a systematic literature search was conducted in July 2021. Of the 2,409 records screened, 40 articles, composed of 38 samples were included. ResultsA total of six non-specific treatment factors (individual, family, academic history, symptoms, abuse and trauma history and relationships) and five specific treatment factors (treatment model, therapeutic intervention, placement decision making, environment and staffing) were reported. ConclusionOnly four non–specific treatment factors and one specific treatment factor appeared in multiple studies while all other factors and sub-factors were not replicated. More research is required to replicate and explore possible specific and non-specific treatment factors associated with internalising and externalising symptoms. The reviewed literature suggested that TRC should target a myriad of non-specific and specific treatment factors to increase the likelihood of success and that family involvement may be a particularly crucial component. Future research should focus on longitudinal studies that explore the long-term impact of non-specific and specific treatment factors on youth during placement and beyond.

Lunchroom-Specific Peer Acceptance and Children's Internalizing Symptoms.

Prior research suggests the elementary school lunchroom is an important context for children's social development. Using a sample of 659 fourth-grade students in 10 public schools (50.7% female; 42.7% Hispanic/Latinx, 30.3% White, 10% Pacific Islander, 7.8% bi/multiracial, 2.2% American Indian, 2.2% Black, 1.9% Asian, and 2.9% other), we examined the association between lunchroom-specific peer acceptance and internalizing symptoms (i.e., depression and social anxiety symptoms). We hypothesized that lunchroom peer acceptance would predict self-rated depression and social anxiety symptoms when controlling for social preference scores. Using hierarchical linear modeling, results indicated self-rated lunchtime peer acceptance scores in December significantly predicted depression symptoms in May when controlling social preference scores and accounted for changes in depression scores across a school year. However, some significant gender differences emerged. Results suggest that elementary school lunchroom interventions should attend to children's perceptions of lunchroom likability and their experiences of depression symptoms.

Relations Between Executive Functioning and Internalizing Symptoms Vary as a Function of Frontoparietal-amygdala Resting State Connectivity.

The prefrontal cortex and the frontoparietal network are associated with a variety of regulatory behaviors. Functional connections between these brain regions and the amygdala are implicated in risk for anxiety disorders. The prefrontal cortex and frontoparietal network are also linked to executive functioning, or behaviors that help orient action towards higher order goals. Where much research has been focused on deleterious effects of under-controlled behavior, a body of work suggests that over-controlled behavior may also pose a risk for internalizing problems. Indeed, while work suggests that high levels of attention shifting may still be protective against internalizing problems, there is evidence that high levels of inhibitory control may be a risk factor for socioemotional difficulties. In the ABCD sample, which offers large sample sizes as well as sociodemographic diversity, we test the interaction between frontoparietal network-amygdala resting state functional connectivity and executive functioning behaviors on longitudinal changes in internalizing symptoms from approximately 10 to 12years of age. We found that higher proficiency in attention shifting indeed predicts fewer internalizing behaviors over time. In addition, higher proficiency in inhibitory control predicts fewer internalizing symptoms over time, but only for children showing resting state connectivity moderately above the sample average between the frontoparietal network and amygdala. This finding supports the idea that top-down control may not be adaptive for all children, and relations between executive functioning and anxiety risk may vary as a function of trait-level regulation.

Anxiety Sensitivity and Internalizing Symptoms: Co-Predictors of Persistent Peer Victimization in Elementary School Children

ABSTRACT Previous research suggests both social contextual and individual difference variables contribute to chronic peer victimization. We tested whether two individual difference variables – anxiety sensitivity (AS) and internalizing symptoms (IS) – predicted persistent peer victimization in elementary school children. Participants were 677 fourth-grade students (51.8% girls) from 10 public elementary schools. We hypothesized that persistent victims would report the highest levels of AS and IS. We also expected that IS would mediate the link between AS and persistent peer victimization. Results indicated that persistent victims reported significantly higher levels of AS and IS than transient or limited victims, and we found evidence that IS functioned as an intermediate variable between AS and persistent peer victimization status. Implications and directions for research are discussed.

Growth mindset, persistence, and self-efficacy in early adolescents: Associations with depression, anxiety, and externalising behaviours

ABSTRACT Growth mindset, persistence, and self-efficacy are important protective factors in understanding adolescent psychopathology, including depression, anxiety, and externalising behaviours. Previous studies have shown that dimensions of self-efficacy (academic, social, and emotional) have differential protective effects with mental health outcomes and these differences vary by sex. This study examines the dimensional mediation of self-efficacy from motivational mindsets on anxiety, depression, and externalising behaviours in a sample of early adolescents ages 10-11. Surveys were administered to participants to measure growth mindset and persistence on internalising and externalising symptoms. The Self-Efficacy Questionnaire for Children (SEQ-C) was used to measure domains of self-efficacy for mediation analysis. Multi-group structural equation modelling by sex indicated that structural paths were not invariant by sex. Significant direct effects were identified from persistence to externalising behaviours in boys, and significant direct effects were identified from growth mindset to depression in girls. In a sample of Tanzanian early adolescents, self-efficacy mediates the protective association between motivational mindsets on psychopathology. Higher academic self-efficacy was associated with reduced externalising problems in both boys and girls. Implications for adolescent programmes and future research are discussed.

To vent or not to vent? The impact of venting on psychological symptoms varies by levels of social support

The current study examined the interaction between venting (as a form of emotional coping) and perceived emotional social support in predicting internalising psychological symptoms (anxiety, depression and somatic symptoms) over time in international students. A short-term longitudinal survey design was employed with three months between two measurement points. Participants were 130 international students from a university in New Zealand. The questionnaire included questions on venting, perceived emotional social support and internalising symptoms. The longitudinal impacts of venting and its interaction with emotional support on internalising symptoms were evaluated using structural equation modelling. Perceived emotional social support significantly moderated the effect of venting on internalising symptoms over time. Specifically, venting was associated with decreased internalising symptoms when students reported low levels of perceived emotional social support. However, venting was associated with increased symptoms when they reported very high levels of perceived support. In the presence of moderate to high emotional support, venting was not associated with changes in internalising symptoms over time, indicating that venting has no significant psychological consequences for international students with moderate to high perceived support. Venting can be an adaptive coping response for those with low perceived support, but it can be harmful in the presence of very high perceived support.

A Longitudinal Investigation of the Relationship Between Trauma-Related Cognitive Processes and Internalising and Externalising Psychopathology in Young People in Out-of-Home Care

Young people in out-of-home care are at increased risk of developing a range of posttrauma mental health difficulties, including PTSD, but more commonly anxiety, depression and externalising symptoms. Cognitive models of PTSD indicate that trauma-related maladaptive appraisals, coping strategies and trauma memory qualities are key processes in the development and maintenance of PTSD, yet there has been limited investigation of the potential role of these processes in broader posttrauma psychopathology, particularly in young people who have been exposed to complex, rather than acute, trauma. We recruited 120 10–18 years olds in out-of-home care, and their caregivers, who completed assessments at two time points: baseline and 12-month follow-up. Young people completed self-report measures of trauma-related maladaptive appraisals, coping strategies and trauma-memory qualities, as well as reporting on PTSD, anxiety, depression and externalising symptoms. Carers also reported on internalising and externalising symptoms. We found that all three cognitive processes were associated with baseline self-reported internalising symptoms, with maladaptive appraisals most robustly associated with both anxiety and depression. Changes in all three processes over 12-months predicted a change in self-reported internalising and externalising symptoms, with maladaptive appraisals and coping predicting anxiety symptoms, and coping uniquely predicting depression and externalising symptoms. Effects remained after controlling for co-occurring PTSD symptoms. Findings were not replicated when using carer-reported symptoms. These findings suggest that existing cognitive models of PTSD may also usefully explain broader posttrauma depression, anxiety and externalising symptoms in young people who have experienced maltreatment and live in out-of-home care. Clinical implications are discussed.