2012 › Trails



Internalizing and externalizing problems: Childhood family instability and mental health problems during late adolescence: A test of two mediation models. The TRAILS study

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

This study tested whether childhood family instability is associated with mental health problems during adolescence through continued family instability or rather through early onset of mental health problems, using data from a prospective population cohort of 2230 Dutch adolescents. Childhood family instability was associated with both internalizing problems and externalizing problems during late adolescence. The association between childhood family instability and adolescent mental health problems largely disappeared when controlling for early onset of mental health problems but only slightly when controlling for continued family instability during adolescence. These patterns were comparable for both types of mental health problems, but relatively stronger for internalizing problems. Growing up in an unpredictable family environment has longlasting negative mental health effects, most of which are due to early onset of mental health problems. Child health care professionals might achieve better longterm results with these at-risk children when they use individual-based interventions rather than family-based interventions.

Internalizing and externalizing problems: Trajectories of psychosocial problems in adolescents predicted by findings from early well-child assessments

Authors: Jaspers M, De Winter AF, Huisman M, Verhulst FC, Ormel J, Stewart RE, Reijneveld SA

Purpose: Research results on trajectories of emotional and behavioral problems are rather heterogeneous. To describe trajectories of emotional and behavioral problems in adolescents and to identify early indicators of these trajectories out of data from routine well-child assessments, at ages 0-4 years. Methods: Data from three assessment waves of adolescents (n=1816) of the Tracking Adolescents’ Individual Lives Survey (TRAILS) were used (ages 11-17). In(formation on early indicators (ages 0-4 years) came from the records of the well-child services. Trajectories of emotional and behavioral problems were based on the parent-reported Child Behavior Checklist (CBCL) and the adolescent-reported Youth Self Report (YSR), filled out at ages 11, 14 and 17. Multinomial logistic regression was used to examine the predictive value of these early indicators on trajectories. Results: For boys and girls we found four trajectories for each outcome, one with high problem levels, and three with middle high, middle low, and low levels. For emotional problems, the type of trajectory was predicted by parental educational level and parental divorce or single parents, for both genders. Moreover, for boys sleep problems were predictive and for girls language problems (odds ratios between 1.53-7.42). For behavioral problems, the trajectories’ type was predicted by maternal smoking during pregnancy, parental educational level, and parental divorce or single parents, for both genders. Moreover, for boys early behavioral problems and attention hyperactivity problems were predictive (odds ratios between 1.64-5.43). Conclusion: Trajectories of emotional and behavioral problems during adolescence are rather stable and can be predicted by a parsimonious set of data from early well-child assessments.

Internalizing and externalizing problems: The TRacking Adolescents' Individual Lives Survey (TRAILS): Design, Current Status, and Selected Findings

Authors: Ormel J, Oldehinkel AJ, Sijtsema JJ, Van Oort FVA, Raven D, Veenstra R, Vollebergh WAM, Verhulst FC

Objectives. (1) To present a concise overview of the sample, outcomes, determinants, non-response and attrition of the ongoing TRacking Adolescents’ Individual Lives Survey (TRAILS), which started in 2001. (2) To summarize a selection of recent findings on continuity, discontinuity, risk, and protective factors of mental health problems. (3) To document the development of psychopathology during adolescence, focusing on whether the increase of problem behavior often seen in adolescence is a general phenomenon or more prevalent in vulnerable teens, thereby giving rise to diverging developmental pathways.
Method. Objectives 1 and 2 were achieved using descriptive statistics and selective review of previous publications; and objective 3 by analyzing longitudinal data on internalizing and externalizing problems using Linear Mixed Models (LMM). Results. The LMM analyses supported the notion of diverging pathways for rule-breaking behaviors but not for anxiety, depression or aggression. Overall, rule-breaking (in both genders) and withdrawn/depressed behavior (particularly in girls) increased, while aggression and anxious/depressed behavior dropped during adolescence. Conclusions. TRAILS has produced a wealth of data and contributed substantially to our understanding of mental health problems and social development during adolescence. Future waves will expand this database into adulthood. The typical development of problem behaviors in adolescence differs considerably across both problem dimensions and gender. Developmental pathways during adolescence suggest accumulation of risk (i.e. diverging pathways) for rule-breaking behavior. However, those of anxiety, depression and aggression slightly converge, suggesting the influence of counter-forces and changes of risk unrelated to initial problem levels and underlying vulnerability.

Internalizing and externalizing problems: Postpartum depression predicts offspring mental health problems in adolescence independently of parental lifetime psychopathology

Authors: Verbeek T, Bockting CL, Van Pampus MG, Ormel J, Meijer JL, Hartman CA, Burger H

Background. Postpartum depression (PPD) follows 5-15% of the life births and forms a major threat to the child's mental health and psychosocial development. However, the nature, continuance, and mediators of the association of postpartum depression (PPD) with the child's mental health are not well understood. The aim of this study was to investigate whether an association between PPD and adolescent mental problems is explained by parental psychopathology and whether the association shows specificity to the internalizing or externalizing domain. Methods. 2729 adolescents aged 10-15 years from the TRacking Adolescents' Individual Life Survey (TRAILS) were included. Both PPD and parental lifetime history of psychopathology were assessed by parent report. Adolescents' psychopathology was assessed using the Achenbach scales (parent, teacher and self report). Linear regression was used to examine the association between PPD and adolescent mental health. Results. We found a statistically significant association of adolescents' internalizing problems with maternal PPD, which remained when adjusted for parental psychopathology. We found no association for externalizing problems. Limitations. Underreporting of both PPD and lifetime parental psychopathology may have occurred due to their retrospective assessment. Conclusions. The association of PPD with internalizing but not externalizing problems extends into adolescence. Parental psychopathology does not explain this association suggesting a direct psychological effect on the child postpartum. If this effect appears causal, early treatment of parental psychopathology may prevent internalizing psychopathology in the offspring, ultimately in adolescence.

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