Internalising Symptoms Research Articles

Cognitive and behavioral predictors of procrastination behavior in adolescents at a mental health clinic in Turkey.

Procrastination behavior (PB) negatively impacts individuals' daily lives. Based on existing evidence that states executive function (EF) problems and internalizing symptoms (IS) are related to PB, this study examined IS, EF problems, and sluggish cognitive tempo (SCT) symptoms in adolescents, and their relationships with PB and gender. The sample consisted of 78 adolescents (56.4% female) aged 12-18years. Participants and their families completed the Children's Depression Inventory (CDI), Screen for Child Anxiety Related Disorders (SCARED), Barkley Sluggish Cognitive Tempo Scale-Children and Adolescent (BSCTS-CA), General and Academic Procrastination Scales, Behavior Rating Inventory of Executive Function (BRIEF), and Strengths and Difficulties Questionnaire (SDQ). The scores for academic PB were significantly positively associated with the CDI, SCARED, subscales comprising the metacognitive index of the BRIEF, and all four subscales of the SDQ but not with SCT. General and academic PB yielded similar results except for the conduct problems. Academic PB and EF problems were more prevalent in males. Lack of organizational skills, a part of EF; IS; and attention problems were associated with academic and general PB in girls and boys. Adolescents who have difficulty organizing their work and attention problems may have higher PB.

Socio-economic inequalities in adolescent mental health in the UK: Multiple socio-economic indicators and reporter effects

There are socio-economic inequalities in the experience of mental ill-health. However, less is known about the extent of inequalities by different indicators of socio-economic position (SEP). This is relevant for insights into the mechanisms by which these inequalities arise. For young people's mental health there is an additional layer of complexity provided by the widespread use of proxy reporters. Using data from the UK Millennium Cohort Study (N ​= ​10,969), we investigated the extent to which five SEP indicators (parent education, household income, household wealth, parent occupational status, and relative neighbourhood deprivation) predict adolescent internalising mental health (at ages 14 and 17 years) and how this varies as a function of reporter. Both parent report and adolescent self-report were considered. Regression models demonstrated that whilst greater disadvantage in all five SEP indicators were associated with greater parent-reported adolescent mental health symptoms, only income, wealth, and occupational status were associated with self-reported mental health symptoms at ages 14 and 17 years. The magnitude of these effects was greater for parent-reported than self-reported adolescent internalising symptoms: SEP indicators jointly predicted 4.73% and 4.06% of the variance in parent-reported symptoms at ages 14 and 17 compared to 0.58% and 0.60% of the variance in self-reported internalising mental health. Household income predicted the most variance in parent reported adolescent internalising symptoms (2.95% variance at age 14 & 2.64% at age 17) and wealth the most for self-reported internalising symptoms (0.42% variance at age 14 & 0.36% at age 17). Interestingly, the gradient and variance explained of parent-reported adolescent mental health across SEP indicators mirrors that of parent's own mental health (for example, income explained 4.89% variance at the age 14 sweep). Our findings highlight that the relevance of different SEP indicators to adolescent internalising mental health differs between parent and adolescent reports. Therefore, it is important to consider the various perspectives of mental health inequalities gained from different types of reporters.

Adverse childhood experiences: Pathways to internalising and externalising problems in young adulthood

AbstractAlthough adverse childhood experiences have been closely linked to a variety of adjustment difficulties in adulthood, less is known about which specific adverse experience or combinations of experiences are differentially predictive of internalising and externalising problems. This would undoubtedly enhance early adverse childhood experiences prevention and intervention programmes. Therefore, this research aims to explore the impact of adverse childhood experiences (abuse and neglect) on deviant behaviour, as well as depressive, anxious and stress symptoms in a community sample of Spanish young adults aged 18–20 years old (N = 270). All participants were recruited using convenience and snowball sampling methods as part of the International Study SOCIALDEVIANCE1820. All answered self‐report questionnaires about sociodemographic issues, adverse childhood experiences as well as current deviant behaviour and current internalising symptoms. Regression and fuzzy‐set qualitative comparative analysis showed that experiencing either physical abuse or a combination of emotional abuse and emotional neglect may lead to externalising problems in men. Internalising problems, however, were linked to the cumulative effect of multiple adverse experiences and were more frequent in women. These pathways to both externalising and internalising problems suggest a differential impact of adverse experiences.

Mental health of autistic adults during the COVID-19 pandemic: The impact of perceived stress, intolerance of uncertainty, and coping style.

Autistic individuals are at particular risk of experiencing mental health problems during the COVID-19 pandemic, yet little is known about personal characteristics that may underlie this vulnerability. This longitudinal questionnaire study with 149 autistic and 147 non-autistic adults investigated the association between perceived stress and anxiety and depressive symptoms, measured 4 months later. In addition, the moderating impact of intolerance of uncertainty and coping styles on this association was examined. Confirming previous studies, autistic adults reported poorer mental health than non-autistic individuals. Results demonstrated similar moderation models across individuals with versus without autism. Perceived stress at timepoint 1 was associated with anxiety and depression at timepoint 2. Across both participant groups, individuals with maladaptive coping strategies and higher levels of intolerance of uncertainty at timepoint 1 showed more internalizing symptoms at timepoint 2. The findings demonstrate the burden of the pandemic on the mental health of autistic adults, especially on those with high levels of perceived stress, maladaptive coping strategies, or intolerance of uncertainty. Interventions to support autistic adults during and after the pandemic might involve providing psychoeducation about the impact of stress, coping, and intolerance of uncertainty on internalizing symptoms, and teaching more adaptive ways to cope with difficult circumstances.Lay abstractMore and more research shows us that autistic individuals are at risk of experiencing mental health problems in response to the COVID-19 pandemic. However, little is known about why this is the case. At two timepoints during the pandemic, we asked 149 autistic and 147 non-autistic adults about feelings of anxiety, depression, and stress, and about characteristics that may explain why some (autistic) people have a larger chance of developing anxiety and depression during this pandemic. In our study, autistic adults experienced more anxiety and depression than non-autistic adults. Across autistic and non-autistic individuals, the people who experienced more stress at timepoint 1 experienced more anxiety and depression 4 months later. This was especially the case for those individuals who use maladaptive coping styles, such as denial or venting, and for those who have difficulties dealing with uncertain situations. Our findings show the burden of the COVID-19 pandemic on the mental health of autistic adults. Interventions to support autistic adults during and after the pandemic are needed, and they may want to focus on the negative impact of stress and teach autistic (and non-autistic) adults more adaptive ways to cope with stressful circumstances.

Emotional Well-Being of Pediatric Brain Tumor Survivors and Comparison Peers: Perspectives From Children and Their Parents.

The aim of this study was to examine the emotional well-being of pediatric brain tumor survivors (PBTS) from the perspective of children's self-reports and parents' reports relative to matched comparison peers (COMP) and their parents. It was hypothesized that PBTS would self-report more depression symptoms, loneliness, and lower self-concept than COMP. We also hypothesized that mothers and fathers of PBTS would report more internalizing symptoms and lower total competence for their children. Age and sex effects were examined in exploratory analyses. Families of 187 PBTS and 186 COMP participated across 5 sites. Eligible children in the PBTS group were 8-15 years of age and 1-5 years post-treatment for a primary intracranial tumor without progressive disease. COMP were classmates matched for sex, race, and age. PBTS self-reported lower scholastic, athletic, and social competence, but not more depression, loneliness, or lower global self-worth than COMP. Parents of PBTS reported more internalizing symptoms and lower total competence than parents of COMP. With few exceptions, group differences did not vary as a function of child age and sex. PBTS reported diminished self-concept in scholastic, athletic, and social domains, while their parents reported broader challenges with internalizing symptoms and total competence. Discrepancies between self-report and parent report require further study to inform targeted interventions for PBTS. Screening survivors for emotional challenges in follow-up clinic or in school setting may help with the allocation of psychosocial support and services for PBTS and their families.

Examination of risk exposure models during COVID-19 in relation to youth life satisfaction and internalizing symptoms

This study examined mediation of a negative COVID-impact on the relationship between risk exposure, and life satisfaction and internalizing symptoms in youth (aged 9–18). Four operationalizations of risk exposure were applied; an Additive versus a Cumulative Risk Model (ARM and CRM), risk clusters and the most salient risk factors. Results showed that a stronger negative COVID-impact is related to lower life satisfaction, more internalizing symptoms and higher additive and cumulative risk. ARM and CRM’s effect on lower life satisfaction is mediated through negative COVID-impact, though not for internalizing symptoms. Clusters of risk factors and risk factors within clusters significantly related to a stronger negative COVID-impact are the clusters ‘Individual factors’ (low self-control), ‘Parenting’ (negative mother–child interaction and low parental responsiveness), ‘Maternal mental health’ and ‘Demographic factors’ (low SES and high paternal education). From all significant risk factors, low self-control, low parental responsiveness, negative mother–child interaction and low SES were most salient.

Witnessing Parental Arrest As a Predictor of Child Internalizing and Externalizing Symptoms During and After Parental Incarceration.

PurposeOne in fourteen children in the United States experiences the incarceration of a parent with whom they have lived. Although prior research has established that witnessing the arrest of a parent is a common occurrence for children of criminal justice-involved parents, child outcomes following such an event are understudied. Little is known about the long-term impacts of witnessing an arrest on children and the extent to which they may vary by child age.MethodsUsing longitudinal data from the Parent Child Study of mothers and fathers incarcerated in state prison, we examine the witnessing of parental arrest as an acute traumatic event and identify the extent to which this type of trauma predicts externalizing and internalizing symptoms for children during their parents’ incarceration and following release.ResultsWitnessing a parent’s arrest predicted greater internalizing behavior concerns while parents were incarcerated, with a greater magnitude of effect for children under eight years of age. Six months post-release of the parent, children younger than age eight who witnessed the arrest showed significantly higher internalizing and externalizing behaviors. No effect was found for children ages eight years or older.ConclusionImplications for future policies to reduce the likelihood of children witnessing parental arrests, as well as the potential benefit of screening for trauma when working with children with incarcerated parents, are discussed.

Targeted community-based programmes for children's mental health: A systematic review and meta-analysis of the Australian literature.

No synthesis of the Australian evidence regarding targeted prevention and early intervention for mental health concerns among young children exists. This review aimed to (1) describe the types of targeted community-based mental health programmes evaluated in Australia to support children aged 1-9 years exhibiting internalising and/or externalising symptoms and (2) examine their impact on children's internalising and externalising symptoms and disorder diagnosis. A systematic review and meta-analysis was conducted (PROSPERO: CRD42021255257). Four databases (PsycINFO, PsycArticles, MEDLINE and CINAHL) were searched for Australian studies published in the past 10 years that quantitatively evaluated the impact of a targeted programme on children's mental health. The National Institute of Health Quality Assessment Tools were used to evaluate the study quality. Forty-two studies were included; the majority (67%) were medium quality. The mean sample size was 142 (SD = 170), children's average age was 5.78 years (SD = 2.44) and 58% were male. Aboriginal and Torres Strait Islander children were underrepresented. Studies evaluated 16 programmes that targeted (1) externalising symptoms (n = 20 studies, n = 6 programmes), (2) internalising symptoms (n = 14 studies, n = 7 programmes) or (3) both, termed transdiagnostic programmes (n = 8 studies, n = 3 programmes). Externalising programmes achieved a significant moderate mean reduction in externalising behaviours (standardised mean differences = -0.56), internalising programmes yielded a small mean improvement in anxiety symptoms (standardised mean differences = -0.25) and 57% reduced odds of anxiety disorder diagnosis. Evidence supporting transdiagnostic programmes was inconclusive. Parenting-focused programmes targeting young children's internalising or externalising behaviours have the largest local evidence base supporting their effectiveness. Limitations include a lack of engagement with fathers, triangulation of outcomes, homogeneity and implementation reporting. Greater implementation and evaluation of community-driven integrated and systemic approaches that identify, engage and support Australia's most disadvantaged cohorts of young children and their families are needed.

Effects of Familism, Parenting, and Family Cohesion on Child Internalizing Symptoms among Mexican Immigrant Families

Effects of Familism, Parenting, and Family Cohesion on Child Internalizing Symptoms among Mexican Immigrant Families

Nocturnal enuresis and related behavioral problems in children

Objectives: The purpose of this study is to investigate how the prevalence of emotional and behavioural issues in a sample of Egyptian youngsters relates to nocturnal enuresis. Methods:The Center of Social and Preventive Medicine at Cairo University's Enuresis specialised outpatient clinic served as the source of 200 of the youngsters for this cross-sectional study. Children in the NE varied in age from 5 to 14 years; their mean age was 8.6 2.3 years. There were just as many boys and girls among the children. Strength and Difficulties Questionnaire was used to evaluate behavioural problems (SDQ). Results: When it comes to emotional scale, 37% of participants fall into the abnormal category, and 41% were labelled abnormal when it comes to hyperactivity and inattention. Although 34% of the individuals reported aberrant scores for all issues, boy's average scores were significantly higher. the existence of behavioural and emotional issues in a sample Females scored lower on the hyperactivity-inattention scale than males (6.5 vs. 4.5; p-value 0.001) In summary, NE is linked to an increased incidence of behavioural issues that point to both internalising and externalising symptoms.

Supplemental Material for Implications of Intergenerational Trauma: Associations Between Caregiver ACEs and Child Internalizing Symptoms in an Urban African American Sample

Supplemental Material for Implications of Intergenerational Trauma: Associations Between Caregiver ACEs and Child Internalizing Symptoms in an Urban African American Sample

Coping with COVID Stress: Maladaptive and Adaptive Response Styles Predicting College Student Internalizing Symptom Dimensions.

The COVID-19 pandemic significantly disrupted daily life for undergraduates and introduced new stressors (e.g., campus closures). How individuals respond to stressors can interact with stress to increase disorder risk in both unique and transdiagnostic ways. The current study examined how maladaptive and adaptive stress response styles moderated the perceived severity of COVID-related stressors effect on general and specific internalizing dimensions at the beginning of the COVID-19 pandemic in a combined undergraduate sample across two universities (N = 451) using latent bifactor modeling and LASSO modeling to identify optimal predictors. Results showed that perceived stress severity and maladaptive response styles (not adaptive response styles or interactions between stress and response styles) were associated with both common and specific internalizing dimensions. Results suggest additive associations of stress severity and maladaptive coping with internalizing symptoms during the pandemic’s beginning, and provide important insights for screening, prevention, and intervention during future public health crises.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10862-022-09975-7.

Inconsistencies between Subjective Reports of Cognitive Difficulties and Performance on Cognitive Tests are Associated with Elevated Internalising and Externalising Symptoms in Children with Learning-related Problems

Children with learning difficulties are commonly assumed to have underlying cognitive deficits by health and educational professionals. However, not all children referred for psycho-educational assessment will be found to have deficits when their abilities are measured by performance on cognitive tasks. The primary aim of this study was to estimate the prevalence of this inconsistent cognitive profile (ICP) in a transdiagnostic sample of children referred by health and education service providers for problems related to attention, learning and memory (N = 715). A second aim was to explore whether elevated mental health problems were associated with ICPs. Findings suggest that approximately half of this sample could be characterised as having an ICP. Cognitive difficulties, whether identified by parent ratings or task performance, were associated with elevated internalising and externalising difficulties. Crucially, a larger discrepancy between a parent’s actual ratings of a child’s cognitive difficulties and the ratings that would be predicted based on the child’s performance on cognitive tasks was associated greater internalising and externalising difficulties for measures of working memory, and greater externalising difficulties for measures of attention. These findings suggest that subjective cognitive difficulties occurring in the absence of any task-based performance deficits may be a functional problem arising from mental health problems.

The role of inflammatory markers and cortisol in the association between early social cognition abilities and later internalising or externalising problems: Evidence from a UK birth cohort

ObjectiveDeficits in social cognition are associated with internalising (emotional and peer problems) and externalising (conduct problems and hyperactivity/inattention) symptoms in youth. It has been suggested that stress may be one of the mechanisms underlying these associations. However, no empirical studies have investigated if physiological stress can explain the prospective associations between social cognition deficits and internalising and externalising symptoms in the general youth population. This study addressed this question and focused on two indicators of physiological stress, dysregulated diurnal cortisol patterns and systemic inflammation. MethodParticipants were 714 individuals from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based birth cohort. Bayesian structural equation modelling was used to investigate a) the associations of social cognition abilities at ages 8, 11, and 14 years with internalising and externalising problems at age 17 years and b) the potential mediating effects of cortisol parameters at age 15 years and inflammatory markers [interleukin 6 (IL-6) and C-reactive protein (CRP)] at ages 9 and 16 years. ResultsWe found that social cognition difficulties were associated with later internalising and externalising problems. Flattened diurnal cortisol slope was associated with hyperactivity/inattention problems two years later. Lower morning cortisol partially mediated the direct association between social communication deficits at 8 years and hyperactivity/inattention and conduct problems at 17 years, even after adjustments for inflammation and confounders (for hyperactivity/inattention: indirect effect = 0.07, 95% CI [0.00, 0.18], p = .042; for conduct problems: indirect effect = 0.04, 95% CI [0.00, 0.11], p = .040). We did not find a significant association between systemic inflammation and social cognition difficulties, internalising problems, or externalising problems. ConclusionOur findings suggest that part of the effect of social communication difficulties in childhood on externalising problems in adolescence was mediated by lower morning cortisol. Hence, our study indicates that the hypoactivity of the hypothalamic–pituitary-adrenal (HPA) axis may be one of the physiological mechanisms linking some social cognition deficits to externalising problems.

Efficacy of Emotion-Focused Parenting Programs for Children’s Internalizing and Externalizing Symptoms: A Randomized Clinical Study

ABSTRACT Objective Emotion-Focused Skills Training (EFST) is a 12-week parental program based on Emotion-Focused Therapy, developed to improve children and adolescents’ mental health problems. Methods In a randomized clinical dismantling study, including parents of 236 children and adolescents (ages 6–13, Mage 8.9, 60.6% boys, 95.8% Caucasian) with externalizing and/or internalizing problems within clinical range, we examined the efficacy of two versions of EFST: one experiential condition (n = 120) involving emotionally evocative techniques and two-chair interventions, and one psychoeducational only condition (n = 116) involving didactic teaching of emotion skills. Both groups received a 2-day group training and 6 hours of individual supervision. Outcomes were parent- and teacher-reported symptoms at baseline, posttreatment, and 4-, 8-, and 12-month follow-up. Analyses were conducted using multilevel growth curve modeling and Bayesian post hoc analysis. Results EFST showed efficacy in reducing parent-reported externalizing (b = −1.72, p < .001, d = 1.0) and internalizing (b = −1.71, p < .001, d = 0.9) symptoms, and teacher-reported externalizing (b = −.96, p < .001, d = 0.4), but not internalizing (b = −.13, p > .05, d = 0.2) symptoms. Multilevel analyses showed nonsignificant differences between conditions (all p’s > .05), although a Bayesian longitudinal sensitivity analysis indicated a better outcome for the experiential condition. Conclusion EFST showed efficacy in symptom reduction for children and adolescents with internalizing and externalizing symptoms. Outcomes were maintained over 12 months for both conditions, supporting EFST as a transdiagnostic parental approach for early intervention.

The association between paternal depression and adolescent internalising problems: A test of parenting style as a mediating pathway

Whilst there is a large evidence base demonstrating the impact of maternal depression on the development of adolescent internalising problems, less is known about the association between paternal depression and adolescent internalising problems, and the mechanisms through which risk is conferred. This study examined the association between paternal depression and adolescent internalising problems, investigating parenting style as a pathway through which this association may be mediated. Participants included 4048 families taking part in the Growing Up in Ireland child cohort study. Self-report measures of paternal depression were completed when the study child was aged 9. Adolescents assessed paternal demandingness, responsiveness and autonomy granting at the age of 13. Adolescent internalising symptoms were measured at the age of 17/18 by the primary caregiver. A parallel multiple mediator model was used to test the total and specific indirect effects of the three parenting styles, whilst controlling for covariates and other mediators in the model. A direct effect of paternal depression on adolescent internalising problems was found (B = .051, 95% CI: 0.020, 0.083). However, no support for mediation via any of the paternal parenting styles (i.e., responsiveness, demandingness, or autonomy-granting) were found. These findings build on an emerging evidence-base demonstrating a specific direct association between paternal depression and adolescent internalising problems, and suggest that interventions ought to also target fathers suffering from depression to help reduce the risk of adolescent internalising problems.

Internalizing problems before and during the COVID-19 pandemic in independent samples of Dutch children and adolescents with and without pre-existing mental health problems

The aim of the study was to assess internalizing problems before and during the pandemic with data from Dutch consortium Child and adolescent mental health and wellbeing in times of the COVID-19 pandemic, consisting of two Dutch general population samples (GS) and two clinical samples (CS) referred to youth/psychiatric care. Measures of internalizing problems were obtained from ongoing data collections pre-pandemic (NGS = 35,357; NCS = 4487) and twice during the pandemic, in Apr–May 2020 (NGS = 3938; clinical: NCS = 1008) and in Nov–Dec 2020 (NGS = 1489; NCS = 1536), in children and adolescents (8–18 years) with parent (Brief Problem Monitor) and/or child reports (Patient-Reported Outcomes Measurement Information System®). Results show that, in the general population, internalizing problems were higher during the first peak of the pandemic compared to pre-pandemic based on both child and parent reports. Yet, over the course of the pandemic, on both child and parent reports, similar or lower levels of internalizing problems were observed. Children in the clinical population reported more internalizing symptoms over the course of the pandemic while parents did not report differences in internalizing symptoms from pre-pandemic to the first peak of the pandemic nor over the course of the pandemic. Overall, the findings indicate that children and adolescents of both the general and clinical population were affected negatively by the pandemic in terms of their internalizing problems. Attention is therefore warranted to investigate long-term effects and to monitor if internalizing problems return to pre-pandemic levels or if they remain elevated post-pandemic.

Mediating Factors in Within-Person Developmental Cascades of Externalising, Internalising and ADHD Symptoms in Childhood

Previous studies have offered evidence for peer problems and academic achievement as mediators in developmental cascades from externalising to internalising problems, and from ADHD symptoms to both internalising and externalising problems. However, these mediators have not been found to fully account for these cascades, indicating that there may be additional mediators involved. This study investigated the role of harsh parenting and parental involvement alongside academic achievement and peer problems in mediating within-person developmental cascades from externalising to internalising problems and from ADHD symptoms to internalising and externalising problems using autoregressive latent trajectory models with structured residuals. Models were fit for parent- and teacher-reports on children’s psychosocial development as measured by the Social Behaviour Questionnaire (SBQ) collected over ages 7, 9, and 11 in an ethnically diverse Swiss longitudinal cohort study (z-proso; N = 1387, 51% male). Results indicated that, when appropriately disentangling within- from between-person effects, none of the considered factors acted as significant mediators in longitudinal within-person relations between ADHD, internalising and externalising problems; hence, mediating mechanisms in developmental cascades remain to be identified.

Prospective Associations Between Peer Victimization and Internalizing Symptoms in Adolescence: The Protective Role of Hope

Prospective Associations Between Peer Victimization and Internalizing Symptoms in Adolescence: The Protective Role of Hope

A qualitative study about engagement in a school-based prevention programme for secondary school students

School-based prevention programmes are one avenue of support for students with internalising symptoms. Research has primarily focused on programme implementation and evaluation, with less emphasis on the experiences of the programme participants and the programme features that influence participant engagement. This qualitative study explores the experiences of secondary school students, aged between 13 to 14 years old, who participated in an abbreviated six-session school-based prevention group programme, the Positive Thoughts and Actions (Singapore) (PTA-SG). The aim was to identify programme features (e.g. programme content and strategies) that contributed to students’ engagement in the PTA-SG programme. One-to-one semi-structured interviews were conducted with eight secondary school students at the end of the programme and transcripts were analysed using reflexive thematic analysis. Students described that the programme 1) incorporated personally meaningful interactive activities, 2) enabled them to gain concrete results and feelings of competence and 3) provided a supportive small-group environment with positive peer modelling. The students’ perspectives about their participation and engagement helps provide recommendations for future development of prevention programmes in secondary schools.