Gonneke W.J.M.Stevens; Wilma A.M.Vollebergh; Trees V.M.Pels Sco Psychiatry Psychiar Epidemiol(2005) 40: Impact factor: Date:99/10/14

 Introduction ◦ Externalizing ◦ Internalizing  Methods  Result  Discussion  Conclusion

 This aim of the current study is to contribute to the knowledge in this field ◦ Externalizing problems ◦ Internalizing problems

 Child factor ◦ Internalizing  According to Zahn-Waxler et al., the strongest risk factor for emotional Problems is gender: Female adolescents were found to be at least twice as likely as males to become anxious and depressed, a pattern that continues throughout adulthood ◦ Externalizing  Associations between child variables and externalizing behavior are well established in literature

 Family factor ◦ Internalizing  Several processes in, and characteristics of, the family influence the development of emotional problems in adolescents ◦ Externalizing  Parental behavior in interaction with the child is the family factor most proximal to the child’s everyday experience

 School/peer factor ◦ Internalizing  Although parents still occupy a central position in the lives of their children, relations with peers become increasingly important during adolescence ◦ Externalizing  The child’s progress into adolescence is marked by increased involvement with peers. In this period, parental influence diminishes whereas peer influence increases

 Migration factor ◦ Internalizing  Moroccan adolescents may be faced with risk factors related to their (or their parents‘) migration ◦ Externalizing  Variables specific for migration, like country of birth and fluency in the language used in the current country may influence the level of externalizing problems in Moroccan immigrant adolescents

 Three goals- Externalizing ◦ First: Gain insight into the predictors of externalizing problems in Moroccan immigrant adolescents living in the Netherlands in the age range of years ◦ Second: The gender specificity of the associations is examined ◦ Third: Want to find out which factor is most strongly associated with externalizing problems in Moroccan immigrant adolescents

 Three goals-Internalizing ◦ First: Gain insight into the predictors of internalizing problems in Moroccan immigrant adolescents living in the Netherlands in the Netherlands ◦ Second: Examine the gender specificity of the associations ◦ Third: Examine the contribution of child, proximal family, parent, contextual family, global family, school/peer, and migration factors to the prediction of emotional problems with and without controlling for the other predictor sets

 Sample Population Aged 4 through 8 At least one parent born in Morocco of two of the four largest cities in Netherlands N=1260 N=1127 For 73% N=819 Parent report N=415 teacher report N=296 Adolescents report Aged 11 through 18 N=376 Response rate 82% N=238 excluded 7 April 2000 to July 2002  Permission for parents and adolescents Only one child per family Excluded 96 Mentally retarded Lived in Moroccan Excluded 37

 Sample

 Instruments ◦ Internalizing and externalizing behavior  Child Behavior Checklist (CBCL)  Youth Self-Report (YSR)  Teacher’s Report Form (TRF)  Internalizing  Sum of scores on items in the Withdraws, Somatic Complaints, and Anxious/Depressed syndrome profiles  Externalizing  Sum of scores on the Delinquent and Aggressive behavior syndromes

 Instruments ◦ Child factor  Gender  Age  Internalizing  Chronic health problems of the child were obtained from the parent Methods

 Instruments ◦ Proximal family factor  Affection  0=highly disagree to 5=highly agree  Monitoring  0=nothing to 3=everything  Support from father (α=0.86)  Support from mother (α=0.78)  Parent-child conflict (parent report α=0.90)  Parent-child conflict (adolescent report α=0.85)  0=never to 4=very often Methods

 Instruments ◦ Parent factor  Somatic symptoms  Anxiety/Insomnia (α=0.90)  Social Dysfunction (α=0.77)  Severe Depression Methods

 Instruments ◦ Contextual family factor  Conflicts parents about parenting  Conflicts parents about other things  0=never to 2=often  Positive communication parents  Destructive communication parents  Total number of life-events Methods

 Instruments ◦ Global family factor  Marital status  0=married  1=not married  Family education level  0=no education at all to 4=high level of vocational training or university  Family employment level  0=no job to 3=high job level  Number of children in the family Methods

 Instruments ◦ School/peer factor  Problems at school  Being bored  0=never to 4=each day  Support from friends (α=0.86)  Deviant peers  0=no; 1=yes (α=0.86)  Hanging out  0=never to 4=each day Methods

 Instruments ◦ Migration factor  Country of birth adolescent  Muslim identification adolescent (α=0.76)  Perceived group discrimination adolescent  Muslim identification parent (α=0.59)  Perceived group discrimination parent  Fluency in Dutch parent (understanding)  Fluency in Dutch parent (speaking)  0=not all to 3=very well Methods

 Statistical analysis ◦ Cross-sectional study ◦ Univariate analysis ◦ Linear regression analysis ◦ Cronbach's alpha

 Externalizing problems

 Internalizing problems

 Externalizing problems Result

 Internalizing problems

internalizingExternalizing Gender externalizingInternalizing Parent-child conflict (parent report) Affection Conflicts parents about parentingMonitoring Perceived group discrimination adolescent Support from father Support from mother Parent-child conflict (parent report) Problems at school Deviant peers Hanging out

 Study limitations ◦ Unable to examine the causal directions of the associations ◦ Unable to test whether the associations about externalizing or internalizing problems between Moroccan immigrant and Western populations ◦ Not all important predictors have been taken into account  temperament for externalizing and internalizing

 Study limitations ◦ Sample might not be representative for the entire Moroccan immigrant population in Netherlands  Almost 50% of the Moroccans ◦ Unable generalized to other migrant populations, as differences between migrant populations are numerous

 Study suggest that the child, school/peer, and proximal family factors are essential in models predicting the development of externalizing and internalizing problems turned out to be relatively small