2011 › Trails



Internalizing and externalizing problems: Reduced cardiac autonomic flexibility associated with medically unexplained somatic complaints in the context of internalizing symptoms in a preadolescent population sample. The TRAILS Study

Authors: Dietrich A, Greaves-Lord K, Bosch NM, Oldehinkel AJ, Minderaa RB, Hoekstra PJ, Althaus M

Medically unexplained somatic complaints (MUSC; e.g., headaches, abdominal pain) are common in youths and may lead to increased medical consumption, poorer academic attainment, and future somatic ill-health. Dysfunction of the autonomic nervous system as one of the major physiological stress systems has been suggested as an important mechanism in MUSC, although literature is still inconsistent. Currently, large-sized studies using a dimensional approach regarding MUSC in youths are lacking, as is research into patterns of physiological functioning that discriminate between MUSC and anxiety and depression symptoms. The aim of this study was to investigate the relationship of dimensionally measured MUSC with high frequency (HF) HRV and baroreflex sensitivity (BRS) in a large preadolescent population cohort, taking into account co-occurring internalizing symptoms. Our study suggests reduced autonomic flexibility (i.e., lower HF-HRV and lower BRS) in relation to MUSC, independent of co-occurring internalizing symptoms and other important confounders. We provide additional evidence to an earlier TRAILS study, which reported a negative association between cardiac measures (HRV, BRS) and somatic-depressive symptoms (e.g., lack of appetite, overtiredness, Bosch et al., 2009), both studies tapping into different aspects of MUSC. We recommend to take account of MUSC in anxiety and depression research in relation to cardiac autonomic functioning, as findings may differ according to the magnitude of co-occurring MUSC.

Internalizing and externalizing problems: Child temperament moderates the impact of parental separation on adolescent mental health. The TRAILS Study

Authors: Sentse M, Ormel J, Veenstra R, Verhulst FC, Oldehinkel AJ

The potential effect of parental separation during early adolescence on adolescent externalizing and internalizing problems was investigated in a longitudinal sample of adolescents (/n/ = 1274; mean age = 16.27; 52.3% girls). Pre-separation mental health problems were controlled for. Building on a large number of studies that overall showed a small effect of parental separation, it was argued that separation may only or especially have an effect under certain conditions. It was examined whether child temperament (effortful control and fearfulness) moderates the impact of parental separation on specific mental health domains. Hypotheses were derived from a goal-framing theory, with a focus on goals related to satisfying the need for autonomy and the need to belong. Controlling for the overlap between the outcome domains, we found that parental separation led to an increase in externalizing problems but not internalizing problems when interactions with child temperament were ignored. Moreover, child temperament moderated the impact of parental separation, in that it was only related to increased externalizing problems for children low on effortful control, whereas it was only related to increased internalizing problems for children high on fearfulness. The results indicate that person-environment interactions are important for understanding the development of mental health problems and that these interactions can be domain-specific.

Internalizing and externalizing problems: Parental psychopathology and socio-economic position predict adolescent offspring's mental health independently and do not interact. The TRAILS Study

Authors: Amone-P’Olak K, Burger H, Huisman M, Oldehinkel AJ, Ormel J

Background: Familial risk factors have been implicated in the development of mental health problems in adolescents. We investigated whether the associations between parental loading as assessed by lifetime psychopathology and offspring internalising and externalising problems were moderated by family socio-economic position (SEP). Two hypotheses of moderation were tested:1. the “Social Push” hypothesis in which parental loading effects are stronger in contexts with low environmental risks and 2) the “Vulnerability” hypothesis in which parental loading effects are stronger in high risk environments. Method: In a population-based sample of 2,149, familial loading and family SEP were assessed at baseline by parent reports. Offspring psychopathology was assessed by reports from multiple informants (parent, self, and teachers). Multiple linear regression was used to assess the independent associations of parental loading and family SEP on offspring psychopathology and their potential interaction. Results: Both family SEP and familial loading had significant independent main effects on offspring internalising and externalising problems. However, the interaction terms were not significant and did not add any explanatory power to the model. Conclusions: Lower levels of family SEP appear not to confer additional risks for mental health problems in offspring of parents with high loading on psychopathology. During early adolescence, parental psychopathology and low family SEP seem independent risk factors for offspring mental health problems. Results do not support either the “Social Push” or “Vulnerability” hypotheses as no evidence of interactions between parental loading and family SEP were found.

Internalizing and externalizing problems: Mental Health Problems During Puberty: Tanner Stage-Related Differences in Specific Symptoms. The TRAILS Study

Authors: Oldehinkel AJ, Verhulst FC, Ormel J

The aim of this study was to investigate associations between specific mental health problems and pubertal stage in (pre)adolescents participating in the Dutch prospective cohort study TRAILS (first assessment: N=2230, age 11.09±0.56, 50.8% girls; second assessment: N=2149, age 13.56±0.53, 51.0% girls). Mental health was assessed by the Youth Self-Report, pubertal (Tanner) stage by parent-rated drawings of secondary sex characteristics. Overall, higher Tanner stages were related to more reported tiredness, irritability, rule-breaking behaviors, and substance use; and fewer fears and somatic complaints. Girls showed increases in social uncertainty, depressed mood, and worries; boys a decrease in self-criticism. Increasing problems during puberty were mostly related to the process of physical maturation, whereas decreasing problems were rather related to general age-related developments. Pubertal timing was associated with different symptoms than pubertal status or age. Puberty seems to affect girls more negatively than boys.

Copyright © 2010 The Association for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Internalizing and externalizing problems: Cannabis use and development of externalizing and internalizing behaviour problems in early adolescence: A TRAILS study

Authors: Griffith-Lendering MFH, Huijbregts SCJ, Mooijaart A, Vollebergh WAM, Swaab H

Aim: To examine the prospective relationship between externalizing and internalizing problems and cannabis use in early adolescence. Materials and Methods: Data were used from the TRAILS study, a longitudinal cohort study of (pre)adolescents (n = 1,449), with measurements at age11.1(T1), age13.6(T2)and age16.3(T3).Internalizing (with drawn behaviour, somatic complaints and depression) and externalizing (delinquent and aggressive behaviour) problems were assessed at all data waves, using the Youth Self Report. Participants reported on cannabis use at the second and third wave. Path analysis was used to identify the temporal order of internalizing and externalizing problems and cannabis use. Results: Path analysis showed no associations between cannabis use(T2-T3) and internalizing problems (T1-2-3). However, cannabis use and externalizing problems were associated (r ranged from.19–.58); path analysis showed that externalizing problems at T1 and T2 preceded cannabis use at T2 and T3, respectively. In contrast, cannabis use(T2) did not precede externalizing problems(T3). Conclusions: These results suggest that in early adolescence, there is no association between internalizing behaviour and cannabis use. There is an association between externalizing behaviour and cannabis use, and it appears that externalizing behaviour precedes cannabis use rather than the other way around during this age period.

Internalizing and externalizing problems: Adolescent Family Adversity and Mental Health Problems: The Role of Adaptive Self-regulation Capacities. The TRAILS Study

Authors: Bakker MP, Ormel J, Verhulst FC, Oldehinkel AJ

Adolescent family adversity is a considerable adaptive challenge in an increasingly turbulent developmental period. Using data from a prospective population cohort of 2230 Dutch adolescents, we tested risk-buffering interactions between adolescent family adversity and selfregulation capacities on mental health. We used two adaptive self-regulation capacities that could allow adolescents to manage relatively well with family adversity: (1) parent-reported effortful control, and (2) an attentional flexibility (in this case, set-shifting) task. Adolescent family adversity was associated with internalizing problems and externalizing problems. The risk-buffering effects of effortful control were found for externalizing problems but not or internalizing problems. There were no risk-buffering effects of attentional flexibility on both types of mental health problems. Effortful control is likely to benefit adolescents’ ability to channel their frustrations in adaptive ways in the presence of family adversity. Additionally, (attentional) set-shifting tasks might have a limited predictive value for risk-buffering research.

Internalizing and externalizing problems: Prenatal Smoking Exposure and the Risk of Behavioral Problems and Substance Use in Adolescence: the TRAILS study

Authors: Monshouwer K, Huizink AC, Harakeh Z, Raaijmakers QAW, Reijneveld SA, Oldehinkel AJ, Verhulst FC, et al.

Objective: To study the prospective relationship between maternal smoking during pregnancy (MSP) and behavioral problems, heavy alcohol use, daily smoking, and ever use of cannabis in the offspring and to assess the role of confounding and mediating factors in a systematic way. Methods: Population based cohort study of 2,230 respondents, starting in 2001 when respondents were around the age of 11 years, and two follow-up measurements at intervals of about 2.5 years (response rates of 96.0% and 81.4%). Results: Almost one third of the respondents’ mothers had smoked tobacco during pregnancy. These respondents were at an increased the risk for all outcomes except internalizing behavioral problems (significant odds ratios ranged from 1.40 to 2.97). The successive models showed that the potential confounding factors reduced the strength of all relationships. In the full model, the strongest relationship was found for mothers who smoked more than 10 cigarettes a day during pregnancy and daily smoking in early adolescence (odds ratio: 1.56), but none of the relationships was statistically significant. Conclusions: MSP is a marker for future behavioral outcomes in the offspring, but reducing the prevalence of MSP is unlikely to make a meaningful contribution to the prevention of these problems in adolescents.

Internalizing and externalizing problems: The relationship between parental religiosity and mental health of pre-adolescents in a community sample. The TRAILS study

Authors: Van der Jagt-Jelsma W, De Vries-Schot M, De Jong R, Verhulst FC, Ormel J, Veenstra R, Swinkels S, e.a.

The purpose of this study is to examine the relationship between parental religiosity, parental harmony on the subject of religiosity, and the mental health of pre-adolescents. In a community-based sample of 2,230 pre-adolescents (10-12 years), mental health problems were assessed using self-report (Youth Self-Report, YSR), parental report (Child Behavior Checklist, CBCL) as well as teacher report (Teacher Checklist for Psychopathology, TCP). Information about the religiosity of mother, the religiosity of father and religious harmony between the parents was obtained by parent report. The influence of maternal religiosity on internalizing symptoms depended on the religious harmony between parents. This was particularly apparent on the CBCL. Higher levels of internalizing symptoms were associated with parental religious disharmony when combined with passive maternal religiosity. Boys scored themselves as having more externalizing symptoms in case of religiously disharmonious parents. The levels of internalizing and externalizing symptoms in pre-adolescents were not influenced by parental religiosity. Religious disharmony between parents is a risk factor for internalizing problems when the mother is passive religious. Religious disharmony is a risk factor on its own for externalizing problems amongst boys. Parental religious activity and parental harmony play a role in the mental health of pre-adolescents.



Internalizing and externalizing problems: The dimensional nature of externalizing behaviors in adolescence: Evidence from a direct comparison of categorical, dimensional, and hybrid models

Authors: Walton KE, Ormel J, Kruger RF

Researchers have recognized the importance of developing an accurate classification system for externalizing disorders, though much of this work has been framed by a priori preferences for categorical vs. dimensional constructs. Newer statistical technologies now allow categorical and dimensional models of psychopathology to be compared empirically. In this study, we directly compared the fit of categorical and dimensional models of externalizing behaviors in a large and representative community sample of adolescents at two time points separated by nearly 2.5 years (N = 2027; mean age at Time 1 = 11.09 years; 50.8% female). Delinquent and aggressive behaviors were assessed with child and parent Child Behavior Checklist reports. Latent trait, latent class, and factor mixture models were fit to the data, and at both time points, the latent trait model provided the best fit to the data. The item parameters were inspected and interpreted, and it was determined that the items were differentially sensitive across all regions of the dimension. We conclude that classification models can be based on empirical evidence rather than a priori preferences, and while current classification systems conceptualize externalizing problems in terms of discrete groups, they can be better conceptualized as dimensions.