Socioeconomic position and mental health problems in pre- and early-adolescents

Background  Family socioeconomic position (SEP) is known to be associated with adolescent mental health. Whether the relationship is different for different mental health dimensions is unknown. Methods  Using a cross-sectional design, we investigated the differential effects of family SEP on multiple mental health dimensions in preadolescents (N = 2230, baseline age 10–12, 49% boys) using reports from multiple informants (parent, self, and teachers). A score equal to or higher than the 85th percentile (averaged across informants) defined mental health problems. Results  SEP was inversely associated with all dimensions. Compared to high SEP, the odds ratios (OR) for externalizing problems were 3.88 (95% confidence interval (CI): 2.56, 5.90) and 2.05 (CI: 1.34, 3.14) for low and intermediate SEP, respectively. For internalizing problems, they were 1.86 (CI: 1.28, 2.70) and 1.37 (CI: 0.94, 2.00), respectively. When adjusted for externalizing problems, SEP effects on internalizing problems materially attenuated (OR: 1.47, CI: 0.78, 1.68 and OR: 1.34, CI: 0.91, 1.96) while the converse was less pronounced (OR: 3.39, CI: 2.24, 5.15) and (OR: 1.91, CI: 1.25, 2.94). Conclusion  In early adolescence, the risk of mental health problems increases with decreasing SEP, particularly for externalizing problems. Further, the SEP-internalizing problems relationship is partly explained by shared aspects with externalizing problems.     

The Impact of Maternal Adverse Childhood Experiences on Offspring’s Internalizing and Externalizing Problems

ObjectiveAdverse childhood experiences (ACEs) are associated with negative physical and mental health outcomes across the lifespan, but research on intergenerational transmission of maternal ACEs and its impact on the offspring’s mental health problems are limited. The study examines the effects of maternal ACEs on the risk of internalizing or externalizing problems among offspring. MethodsThere were 450 mother-child dyads. Mothers completed the Adverse Childhood Experiences Questionnaire. The child outcomes included internalizing and externalizing problems assessed by the Korean Child Behavior Checklist (K-CBCL) and Korean Youth Self-Report (K-YSR), depression assessed by the Center for Epidemiological Studies Depression Scale for Children (CES-DC) and anxiety assessed by the Screen for Child Anxiety Related Emotional Disorders (SCARED). Results36.1% of mothers experienced at least one ACE, and 11.1% experienced three or more ACEs. Cumulative maternal ACEs were associated with internalizing problems, externalizing problems, depression and anxiety in the offspring. Household dysfunction from maternal ACEs was significantly associated with delinquent behavior, anxiety/depression, and somatic complaints in the offspring. ConclusionThe findings support the hypothesis that maternal ACEs are related to mental health problems in the offspring. Further research is needed to determine the factors mediating intergenerational transmission as well as intervention strategies to prevent ACEs and mental health problems in the offspring.     

Perceived rather than actual overweight is associated with mental health problems in adolescence

Background: Overweight and perceived overweight are common among adolescents. The nature of the relationship between overweight/perceived overweight and mental health problems is still unclear.

Aims: The aim of this study was to examine whether actual overweight, perceived overweight or both are associated with internalizing and externalizing disorders among adolescents.

Methods: Data were collected by two similar school surveys in all Finnish-speaking secondary schools in Tampere (population 200,000) in the academic years 2002–2003 and 2012–2013. A total of 2775 acceptable responses were received. All the analyses were carried out separately for girls and boys. Mean age of the respondents was 15.6 years.

Results: In multivariate analyses perceived overweight, not actual weight, was significantly associated with higher risk of self-reported depression (OR: 4.3, 95% CI: 2.9–6.3, p?p?p?=?.001) and self-reported social phobia (OR: 2.4, 95% CI: 1.0–5.6, p?=?.05) in boys.

Conclusion: Perceived overweight rather than actual weight status is associated with both internalizing and externalizing mental health problems in adolescents.     

Prenatal smoking and internalizing and externalizing problems in children studied from childhood to late adolescence

ObjectiveTo study whether prenatal smoking only relates to externalizing problems or whether it is associated with both internalizing and externalizing problems from childhood into late adolescence.MethodChild Behavior Checklist-derived, parent-reported internalizing and externalizing problems of 396 children were longitudinally assessed at ages 5, 10 to 11, and 18 years. The influence of self-reported prenatal smoking on the course of internalizing and externalizing problems over these ages was assessed, controlling for the co-occurrence of internalizing and externalizing problems and co-occurring pre- and perinatal risk factors, demographic characteristics, maternal mental health, and child social and attention problems.ResultsChildren whose mothers had smoked during pregnancy had increased levels of both internalizing and externalizing problems over the period of ages 5 to 18 years when compared with children whose mothers did not smoke during pregnancy. These associations remained significant after controlling internalizing for externalizing and vice versa and possible confounding variables.ConclusionsMaternal smoking during pregnancy is a predictor of internalizing as well as externalizing psychopathology in offspring. The association between prenatal smoking and internalizing and externalizing problems persists throughout childhood and late adolescence. J. Am. Acad. Child Adolesc. Psychiatry, 2008; 47(7):779–787.     

The relationship between neighborhood-level socioeconomic characteristics and individual mental disorders in five cities in Latin America: multilevel models from the World Mental Health Surveys

Purpose

Our understanding of community-level predictors of individual mental disorders in large urban areas of lower income countries is limited. In particular, the proportion of migrant, unemployed, and poorly educated residents in neighborhoods of these urban areas may characterize group contexts and shape residents’ health.

Methods

Cross-sectional household interviews of 7251 adults were completed across 83 neighborhoods of Buenos Aires, Argentina; Medellín, Colombia; São Paulo, Brazil; Lima, Peru; and Mexico City, Mexico as part of the World Mental Health Survey Initiative. Past-year internalizing and externalizing mental disorders were assessed, and multilevel models were used.

Results

Living in neighborhoods with either an above-average or below-average proportion of migrants and highly educated residents was associated with lower odds of any internalizing disorder (for proportion migrants: OR 0.75, 95% CI 0.62–0.91 for the bottom tertile and OR 0.79, 95% CI 0.67–0.94 for the top tertile compared to the middle tertile; for proportion highly educated: OR 0.76, 95% CI 0.64–0.90 for the bottom tertile and OR 0.58, 95% CI 0.37–0.90 for the top tertile compared to the middle tertile). Living in neighborhoods with an above-average proportion of unemployed individuals was associated with higher odds of having any internalizing disorder (OR 1.49, 95% CI 1.14–1.95 for the top tertile compared to the middle tertile). The proportion of highly educated residents was associated with lower odds of externalizing disorder (OR 0.54, 95% CI 0.31–0.93 for the top tertile compared to the middle tertile).

Conclusions

The associations of neighborhood-level migration, unemployment, and education with individual-level odds of mental disorders highlight the importance of community context for understanding the burden of mental disorders among residents of rapidly urbanizing global settings.

     

Exploring childhood temperament as a moderator of the association between adolescent sexual minority status and internalizing and externalizing behavior problems

IntroductionSexual minority youth experience worse mental health compared to their heterosexual peers, reflecting the consequences of sexual minority-based stigma. Previous research has focused on contextual variation to understand variability within this vulnerability. Childhood temperament factors such as negative affect, effortful control and surgency/extraversion are important for understanding differential susceptibility to environmental stressors. The objective of the current study was to understand how childhood temperament factors, measured prior to the most difficult developmental period for sexual minority youth, moderated the association between sexual minority status and internalizing and externalizing behavior problems.MethodsYouth reporting same-sex attraction in an ongoing longitudinal project on the development of conduct problems in Quebec, Canada were matched with heterosexual peers, for an analytic sample of 280 youth (62% girls). Structural equation models were used to examine (1) the association between youth-reported same-sex attraction (ages 13–16) and parent and youth-reported internalizing and externalizing problems a year later at ages 14–17, and (2) the moderating role of temperament (ages 6–9) in this association between sexual minority status and internalizing and externalizing problems.ResultsSame-sex attraction was associated with higher levels of youth-reported internalizing and externalizing behavior problems. Surgency/extraversion moderated the association between sexual minority status and youth-reported internalizing and externalizing problems.ConclusionsThese findings suggest that temperament linked to individual visibility may be important for understanding variation in self-reported mental health among sexual minority youth, and supports the use of developmental constructs like temperament to better understand vulnerability to psychosocial difficulties within this population.     

Familial and neighborhood effects on psychiatric disorders in childhood and adolescence

BackgroundMore knowledge is needed on potential associations between individual-, family-, and neighborhood-level factors and psychiatric disorders in children and adolescents.AimsTo examine associations between, individual-, family-, and neighborhood-level factors and incident internalizing (anxiety and mood) disorders and externalizing (ADHD and conduct) disorders in children and adolescents, and to estimate the relative contributions of family and neighborhood to individual variation in these disorders.MethodWe performed a three-level logistic regression on all 542,195 children born in Sweden in 1992–1996, nested in 427,954 families, which in turn were nested in 8475 neighborhoods. The children were followed from 2000 to 2010 for incident internalizing and externalizing psychiatric disorders, assessed from medical records.Results26,514 children (4.8%) were diagnosed with internalizing or externalizing psychiatric disorders. Approximately 29% of the total individual variance in internalizing disorders could be attributed to the family level, which includes both genetic and family environmental effects, and 5% to the neighborhood level. The corresponding figures for externalizing disorders were 43.5% and 5.5%, respectively. After adjustment for individual-level sociodemographic factors, high neighborhood deprivation was associated with increased risks of externalizing and internalizing psychiatric disorders (odds ratio [OR] = 1.37, 95% credible interval [CI] = 1.25–1.50 and OR = 1.34, 95% CI = 1.25–1.45, respectively), including conduct disorder (OR = 2.01, 95% CI = 1.58–2.55), anxiety disorders (OR = 1.40, 95% CI = 1.29–1.52), and mood disorders (OR = 1.21, 95% CI, 1.09–1.35). The strongest association between neighborhood deprivation and ADHD was observed in moderately deprived neighborhoods (OR = 1.31, 95% CI = 1.19–1.44).ConclusionsThese findings call for policies to promote mental health that consider potential influences from children's family and neighborhood environments.conclusionTrial registrationNot applicable.     

A prospective study of sleep problems in children with ADHD

BackgroundBehavioral sleep problems are common in children with attention-deficit/hyperactivity disorder (ADHD), yet their persistence or otherwise is unknown. We examined behavioral sleep problem trajectories, types of sleep problems experienced, and associated risk/protective factors.MethodsDesign: Prospective cohort study. Setting: Twenty-one pediatric practices across Victoria, Australia. Participants: A total of 195 children with ADHD (5–13 years). Outcomes: Sleep problem trajectories classified as never, transient, or persistent on the basis of sleep problem severity measured at baseline, 6, and 12 months. Explanatory variables: Types of sleep problems, internalizing and externalizing comorbidities, ADHD symptom severity and medication use, autism spectrum disorder, caregiver mental health, and sociodemographic factors. Analyses: Multinomial logistic regression models.ResultsSleep problems fluctuated over 12 months, but for 10% of children they persisted. In adjusted analyses, co-occurring internalizing and externalizing comorbidities were a risk factor for persistent (odds ratio (OR) 9.2, 95% confidence interval (CI) 1.6, 53.9, p = 0.01) and transient (OR 3.7, 95% CI 1.5, 8.8, p = 0.003) sleep problems, while greater ADHD symptom severity and poorer caregiver mental health were risk factors for persistent and transient sleep problems, respectively.ConclusionsSleep problems in children with ADHD are commonly transient, but in a subgroup they are characterized as persistent. Early preventive/intervention strategies should target children at risk of persistent sleep problems.     

The link between ethnicity,social disadvantage and mental health problems in a school-based multiethnic sample of children in the Netherlands

To investigate to what extent differences in prevalence and types of mental health problems between ethnic minority and majority youth can be explained by social disadvantage. Mental health problems were assessed in a sample of 1,278 schoolchildren (55 % Dutch, 32 % Moroccan and 13 % Turkish; mean age: 12.9 ± 1.8) using the Strengths and Difficulties Questionnaire self-report and teacher report. Measures of family socioeconomic status, neighbourhood deprivation, perceived discrimination, family structure, repeating a school year, housing stability and neighbourhood urbanization were used as indicators of social disadvantage, based on which a cumulative index was created. Ethnic minority youth had more externalizing and fewer internalizing problems than majority youth. Perceived discrimination and living in an unstable social environment were associated with mental health problems, independent of ethnicity. A dose–response relationship was found between social disadvantage and mental health problems. The adjusted odds ratio for mental health problems was 4.16 (95 % CI 2.49–6.94) for more than four compared with zero indicators of social disadvantage. Social disadvantage was more common in ethnic minority than in majority youth, explaining part of the differences in prevalence of mental health problems. Ethnic minority youth in the Netherlands have a different profile of mental health problems than majority youth. In all ethnic groups, the risk of mental health problems increases with the degree of social disadvantage. The higher prevalence of externalizing problems among ethnic minority youth is explained partly by their disadvantaged social position. The findings suggest that social factors associated with ethnicity are likely to explain mental health problems in ethnic groups.     

Structure and trends of externalizing and internalizing psychiatric symptoms and gender differences among adolescents in the US from 1991 to 2018

Purpose

We aimed to estimate the structure of internalizing and externalizing symptoms and potential time dynamics in their association. This is understudied among adolescents, despite increasing internalizing and decreasing externalizing symptoms in recent years.

Methods

We analyzed data from US Monitoring the Future cross-sectional surveys (1991–2018) representative of school-attending adolescents (N = 304,542). Exploratory factor analysis using maximum likelihood estimation method and promax rotation resulted in a two-factor solution (factor correlation r = 0.24) that differentiated eight internalizing and seven conduct-related externalizing symptoms. Time-varying effect modification linear regression models estimated the association between standardized internalizing and externalizing symptoms factor scores over time overall and by gender.

Results

In 2012, trends in average factor scores diverged for internalizing and externalizing factors. The average standardized internalizing factor score increased from − 0.03 in 2012 to 0.06 in 2013 and the average externalizing factor score decreased from − 0.06 in 2011 to − 0.13 in 2012. We found that for every one-unit increase in standardized internalizing factor score, standardized externalizing factor score increased by 0.224 units in 2010 (95% CI: 0.215, 0.233); the magnitude of this increase was 22.3% lower in 2018 (i.e., 0.174 units; 95% CI: 0.160, 0.188). Decoupling of internalizing and externalizing symptoms began earlier among boys (~ 1995) than among girls (~ 2010).

Conclusion

The decoupling of internalizing and externalizing symptoms among adolescents suggests that changes in the prevalence of shared risk factors for adolescent psychiatric symptoms affect these dimensions in opposing directions, raising the importance of considering symptoms and their risk factors together in prevention and intervention efforts.

     

Socioeconomic status and children’s mental health: results from the Bergen Child Study

Purpose

It is generally accepted that mental health problems are unequally distributed across population strata defined by socioeconomic status (SES), with more problems for those with lower SES. However, studies of this association in children and adolescents are often restricted by the use of global measures of mental health problems and aggregation of SES-indicators. We aim to further elucidate the relationship between childhood mental health problems and SES by including more detailed information about mental health and individual SES-indicators.

Methods

The participants (N?=?5,781, age 11–13) were part of the Bergen Child Study (BCS). Mental health was assessed using the teacher, parent and self-report versions of the Strengths and Difficulties Questionnaire (SDQ), including an impact section, used to measure symptom dimensions and probability of psychiatric disorders. Parent reports of family economy and parental education were used as SES measures.

Results

For each SES indicator we confirmed an inverse relationship across all the symptom dimensions. Poor family economy consistently predicted mental health problems, while parental education level predicted externalizing disorders stronger than internalizing disorders.

Conclusion

In this Norwegian sample of children, family economy was a significant predictor of mental health problems as measured across a wide range of symptom dimensions and poor economy predicted a high probability of a psychiatric disorder. Longitudinal studies of the impact of low family income as well as other SES factors on externalizing and internalizing symptom dimensions and disorders are called for.     

Determinants of mental health service use among depressed adolescents

Objective

Evaluate determinants of mental health service use among depressed adolescents.

Method

We assessed mental health services use over the 12 months following screening among 113 adolescents (34 males, 79 females) from an integrated healthcare system who screened positive for depression (Patient Health Questionnaire-9 score ≥ 11). Youth characteristics (demographics, depression severity, and co-morbidity) and parent characteristics (parent history of depression, parent-report of youth externalizing and internalizing problems) were compared among youth who had received mental health services and those who had not. Multivariate regression was used to evaluate the strongest factors associated with mental health service use.

Results

Overall, 52% of adolescents who screened positive for depression received mental health service in the year following screening. Higher parent-reported youth internalizing problems (OR 5.37, CI 1.77–16.35), parental history of depression/anxiety (OR 4.12, CI 1.36–12.48) were significant factors associated with mental health service use. Suicidality and functional impairment were not associated with increased mental health services use.

Conclusion

Parental factors including recognition of the adolescent's internalizing symptoms and parental experience with depression/anxiety are strongly associated with mental health service use for depressed adolescents. This highlights the importance of educating parents about depression and developing systems to actively screen and engage youth in treatment for depression.     

Low education and mental health among older adults: the mediating role of employment and income

Purpose

Transition from work to retirement may be associated with poor mental health outcomes in older-age groups, especially among those of lower socio-economic position (SEP). This study investigates the association between low educational achievement and mental health status, and the mediating role of employment status and income level among older-age Australians.

Methods

This study was based on the ‘45 and Up Study’, a prospective cohort study of participants from New South Wales (Australia) aged 45 years and older (N = 267,153), followed-up over the period 2006–2018. A causal mediation analysis was used to assess the total causal effect (TCE) of educational achievement level on psychological distress, and the extent of mediation by employment status and income level.

Results

Lower educational achievement was associated with subsequent psychological distress, with a stronger TCE among those with low educational achievement (OR = 1.46, 95% CI 1.25–1.72), followed by those with intermediate educational achievement (OR = 1.26, 95% CI 1.07–1.48), compared to those with high educational achievement. In models investigating mediation by employment status and income level, 44.7%, (95% CI 34.2–55.3) of the association was mediated by employment status and income level, with a stronger mediating effect evident for income level.

Conclusion

Findings suggest that employment status and income level changes at older age are more strongly associated with poorer mental health among those of lower SEP. Poor mental health associated with lower SEP may be ameliorated particularly by changes to income level, but also how people transition from employment to retirement.

     

Patterns of agreement among parent, teacher and youth ratings in a referred sample

ObjectiveThe purpose of this study was to investigate the degree of agreement among parents, teachers and adolescents with respect to the Child Behavior Checklist (CBCL), the Teacher's Report Form (TRF), and the Youth Self Report (YSR). In addition we evaluated the suitability of these three forms (CBCL, TRF and YSR) in terms of their contribution to understanding internalizing and externalizing disorders in youths being referred to a child and adolescent unit of a psychiatric care facility.MethodsA total of 611 patients aged 11–18 years (mean age 13.0, SD 1.6) were assessed using the CBCL, the TRF and the YSR.ResultsIntraclass coefficients (ICC) showed low to moderate agreement among informants. Furthermore, the level of agreement was generally less among patients suffering from internalizing disorders than for young patients who displayed externalizing disorders. Logistic regression revealed that the TRF internalizing syndrome scale, the CBCL internalizing syndrome scale and gender were relevant prognostic factors for the occurrence of internalizing disorders in youth. The YSR internalizing syndrome scale, on the other hand, was not a relevant factor among adolescents of a clinical target population. Likewise, only the TRF externalizing syndrome scale, the CBCL externalizing syndrome scale and gender were relevant prognostic factors for the occurrence of externalizing disorders in youth.ConclusionsParticularly the CBCL and TRF are useful instruments in assessing internalizing and externalizing disorders in adolescents referred to a mental health setting.     

Early childhood internalizing problems,externalizing problems and their co-occurrence and (mal)adaptive functioning in emerging adulthood: a 16-year follow-up study

Purpose

A vast amount of studies suggest that internalizing or externalizing problems are related to individual functioning, and often co-occur. Yet, a focus on their additive and interactive effects is scarce. Furthermore, most research has focused on a limited number of developmental domains and mostly on maladaptive functioning. Therefore, the current prospective study examined whether early childhood (ages 4–8) internalizing and externalizing problems and their interaction were related to a broad range of (mal)adaptive functioning outcomes in emerging adulthood (ages 20–24).

Methods

Data from the Flemish Study on Parenting, Personality and Development were used. At Time 1 (1999) mothers of 374 children (45% boys) and fathers of 357 children (46% boys) rated internalizing and externalizing problems through the Child Behavior Checklist. Outcomes in emerging adulthood were measured through self-reports 16 years later across the following domains: psychological functioning, social functioning, work, physical health, and self-concept.

Results

Early externalizing problems were related to maladaptive outcomes on the psychological and social domains. With regard to adaptive functioning, externalizing problems were associated with lower satisfaction regarding general health on the physical domain. Early internalizing problems were not associated with any emerging adulthood outcomes. The interaction of (father reported) internalizing and externalizing problems was related to aggressive behavior.

Conclusion

Early childhood externalizing problems were associated with maladaptive and adaptive functioning over a time span of 16 years. The results add to studies on the implementation of prevention and intervention programs in early childhood and to the value for developing personalized interventions.

     

Mental health of single fathers living in an urban community in South Korea

ObjectiveThe aims of this study were to understand the mental health of single fathers relative to married fathers as the population of single fathers continues to increase and to use the resultant data for the establishment of public health policies.MethodsWe evaluated the mental health of 58 single fathers and 256 married fathers living in an urban community in South Korea. Self-reported questionnaires including the Global Assessment of Recent Stress, Center for Epidemiologic Studies–Depression, Scale for Suicidal Ideation, the Korean version of the Alcohol Use Disorder Identification Test, and the World Health Organization Quality of Life Assessment Instrument were used for evaluation. The mental health scale scores and the prevalence of mental health problems were compared between the single and the married fathers. We also assessed the factors associated with poor QOL, depressive symptoms, and severe stress among single fathers.ResultsThe single fathers had poorer quality of life (OR 7.30, 95% CI 2.82–18.74), more depressive symptoms (OR 3.85, 95% CI 1.29–11.45), and more stress (OR 3.36, 95% CI 1.25–8.98) than did the married fathers even after controlling for socio-demographic factors. Among the single fathers, poor socioeconomic conditions, such as no house ownership, manual occupations, having two or more children, and having a youngest child in elementary school or middle school, were significantly associated with poorer mental health.ConclusionsThis study demonstrated that single fathers have poorer mental health than do married fathers. Single parenthood was significantly associated with their mental health. Therefore, we should attempt to provide practical support to reduce the social burden and offer earlier psychological interventions to reduce distress in single fathers.     

The effect of gender on mental health service use: an examination of mediation through material,social and health-related pathways

Purpose

We aimed to understand how much of the gender difference in mental health service use could be due to the joint mediation of employment, behavioural and material factors, social support and mental health need.

Methods

We used data from employed individuals aged 18–65 years who participated in the 2015–2017 waves of the Household, Income and Labour Dynamics in Australia survey. The exposure (male, female) and confounders were measured in 2015, mediators in 2016 and the outcome—whether a person had seen a mental health professional in the previous year—was measured in 2017. We estimated natural mediation effects using weighted counterfactual predictions from a logistic regression model.

Results

Men were less likely to see a mental health care provider than women. The total causal effect on the risk difference scale was  − 0.045 (95% CI  − 0.056,  − 0,034). The counterfactual of men taking the mediator values of women explained 28% (95% CI 1.7%, 54%) of the total effect, with the natural direct effect estimated to represent an absolute risk difference of  − 0.033 (95% CI  − 0.048,  − 0.018) and the natural indirect effect  − 0.012 (95% CI  − 0.022,  − 0.0027).

Conclusion

Gendered differences in the use of mental health services could be reduced by addressing inequalities in health, employment, material and behavioural factors, and social support.

     

Family factors contributing to emotional and behavioral problems in Korean adolescents with epilepsy

PurposeWe aimed to determine whether different aspects of family functioning are associated with emotional and behavioral problems in adolescents with epilepsy and, if not, to document any indirect associations mediated by other family factors.MethodsThis was a cross-sectional, multicenter study. A total of 297 adolescents with epilepsy and their parents participated. Adolescent psychopathology was measured using the Youth Self-Report. Family factors were classified into proximal (parent–child interaction), distal (parent characteristics), and contextual factors (family characteristics) in accordance to their level of proximity to the adolescent's everyday life. Regression analyses were used to analyze the unique and combined predictive power of family factors in relation to psychopathology.ResultsIn total, 44 (14.8%) and 51 (17.2%) adolescents with epilepsy scored above the borderline cutoff (T-score ≥ 60) of internalizing and externalizing problems, respectively. Proximal and distal factors were independently associated with both internalizing and externalizing problems. High levels of parental depressive mood and parental overcontrol were the strongest factors contributing to internalizing and externalizing problems, respectively. Contextual factors were indirectly associated with both internalizing and externalizing problems through more proximal factors.ConclusionsBoth proximal and distal family factors affect psychopathology in Korean adolescents with epilepsy. Parental feelings of depression and parental overcontrol are the strongest factors contributing to internalizing and externalizing problems, respectively.     

Childhood Problem Behaviors and Death by Midlife: The British National Child Development Study

ObjectiveTo examine childhood problem behaviors manifested as externalizing behaviors (e.g., aggression, impulsivity) and internalizing behaviors (e.g., anxiousness, avoidant behavior) as predictors of mortality by the age of 46 years and to assess whether these associations are dependent on childhood family background.MethodThe participants were 5,426 girls and 5,716 boys born in 1958 and participants in the British National Child Development Study (total N = 11,142). Childhood problem behaviors were assessed by teachers at ages 7 and 11 years, and the participants were followed for mortality to the age of 46 years.ResultsBoth externalizing and internalizing behaviors were associated with mortality in adulthood. By the age of 46 years, the cumulative probabilities of death by increasing externalizing score quartiles were 1.4%, 2.2%, 2.3%, and 3.2%, respectively (odds ratio [OR] for mortality per 1 SD increase in standardized externalizing score 1.27; 95% confidence interval [Cl] 1.13–1.44). The corresponding percentages for internalizing score quartiles were 1.8%, 1.9%, 2.3%, and 3.0% (OR 1.20; 95% Cl 1.06–1.35). Adjusting for father's social class, family difficulties, family size, and cognitive ability attenuated these associations for externalizing behaviors (OR 1.21; 95% Cl 1.06–1.37) and for internalizing behaviors (OR 1.11; 95% Cl 0.98–1.26). Childhood environment did not modify the association between problem behaviors and mortality.ConclusionsChildhood problem behaviors are associated with increased long-term mortality risk beyond childhood and adolescence.     

Trauma exposure in children with and without ADHD: prevalence and functional impairment in a community-based study of 6–8-year-old Australian children

Both ADHD and trauma exposure are common childhood problems, but there are few empirical data regarding the association between the two conditions. The aims of this study were to compare lifetime prevalence of trauma exposure in children with and without ADHD, and to explore the association between trauma exposure and outcomes in children with ADHD. Children aged 6–8 years with ADHD (n = 179) and controls (n = 212) recruited from 43 schools were assessed for ADHD, trauma exposure and comorbid mental health disorders using the Diagnostic Interview Schedule for Children IV. Outcome data were collected by direct child assessment, parent report and teacher-report, and included ADHD symptom severity, internalizing and externalizing problems, quality of life, and academic functioning. Logistic and linear regression models were used to examine differences adjusted for child and family socio-demographics. Children with ADHD were more likely than controls to have ever experienced a traumatic event (27 vs 16%; OR: 1.99; 95% CI 1.21, 3.27). This difference remained significant in the adjusted model (OR: 1.76, 95% CI 1.03, 3.01) accounting for child factors (age and gender) and family socio-demographic factors (parent age, parent high school completion and single parent status). Among those with ADHD, trauma-exposed children had higher parent-reported ADHD severity and more externalizing problems than non-exposed children, however, this effect attenuated in adjusted model. Children with ADHD were more likely to have experienced a traumatic event than controls. The high prevalence of trauma exposure in our sample suggests that clinicians should evaluate for trauma histories in children presenting with ADHD.