Internalizing and externalizing problems in childhood and adolescence as predictors of work incapacity in young adulthood

Trajectories of Problem Behaviors and Information Technology Use Among Adolescents: A Latent Growth Model Using the Korean Children and Youth Panel Survey

We investigated the association between computer and mobile phone online activities and adolescents' problem behaviors (e.g., depressive symptoms, withdrawal, somatic complaints, attention deficit, and aggression) using data from the Korean Children and Youth Panel Survey and latent growth model analysis. The results demonstrated that text-related activities lowered withdrawal and attention deficit. Higher use of online communities or personal websites was associated with higher depressive symptoms, withdrawal, somatic symptoms, and aggression. Online gaming increased both attention deficit' initial value and its decrease rate. Taking photos decreased withdrawal. Watching videos increased depressive symptoms, withdrawal, and attention deficit. Listening to music lowered attention deficit' initial value and somatic symptoms' decrease rate. Accessing adult websites increased attention deficit and aggression. Educational information searches reduced attention deficit and aggression. Online transactions increased somatic symptoms. This study indicates that adolescents' problem behaviors may appear differently depending on the type of information technology use.

Family and Peer Social Capital and Child Behavioral Outcomes in Japan

BACKGROUND/OBJECTIVES

Child problem behaviors have been linked to immediate and long-term negative outcomes. Research has found that family and peer social capital have a strong influence on child behavioral outcomes. However, most research about social capital and child behavior problems has been conducted in Western contexts. Social capital may influence child behavior problems differently in non-Western sociocultural environments due to different family and peer dynamics.

METHODS

Using a sample from the Japan Household Panel Survey and Japan Child Panel Survey (N = 182), we expand this literature on various forms of social capital to the Japanese context with data that were collected between 2009 and 2014. We examine the relationship of family and peer social capital with children internalizing and externalizing problem behaviors using OLS linear regression.

RESULTS

Our results differ from what is commonly found in Western contexts. Whereas family and peer social capital are typically associated with both internalizing and externalizing problem behaviors in Western countries, we find that greater family social capital is associated with decreased externalizing problem behaviors but not internalizing problem behaviors in Japan, and peer social capital has no association on either type of problem behaviors.

CONCLUSIONS

Our findings emphasize the importance of considering social and cultural contexts when exploring how social capital might encourage prosocial child outcomes.

The Relation between Residential Mobility and Internalizing and Externalizing Problems in Adolescence: The Role of Subjective Moving Experience, Gender, and Friendship Quality

Adolescent residential mobility can be a stressful life event, potentially aggravating internalizing or externalizing problems. However, the longitudinal effects of residential mobility are understudied and may be context-dependent. This study investigates the longitudinal associations between adolescent residential mobility and internalizing and externalizing problems. Additionally, this study examines for whom residential moves are most detrimental by including subjective moving experience, gender, and friendship quality before the move as moderators. Longitudinal data from 2,029 adolescents (51% female) from the TRacking Adolescents' Individual Lives Survey (TRAILS) were used (Mage [SD] at T1 = 11.1 [0.55], T2 = 13.6 [0.52], and T3 = 16.3 [0.70]). Results from stepwise multi-level random-effect models showed that adolescents who experienced an unpleasant move remained stable in internalizing problems, while others decreased over time. Adolescents who moved increased stronger in externalizing problems than adolescents who did not move, independent of whether they experienced the move as unpleasant. Gender and friendship quality before the move did not moderate the relation between residential mobility and internalizing or externalizing problem development. These results emphasize that residential moves in adolescence, especially when experienced as unpleasant, can have long-lasting negative effects on adolescent development.

Parenting style and child mental health at preschool age: evidence from rural China

BACKGROUND

Mental health problems among children at preschool age are a common issue across the world. As shown in literature, a caregiver's parenting style can play a critical role in child development. This study aims to examine the associations between a caregiver's parenting style and the mental health problems (or not) of their child when he/she is at preschool age in rural China.

METHODS

Participants were children, aged 49 to 65 months, and their primary caregivers. The primary caregivers of the sample children completed the Parenting Styles and Dimensions Questionnaire, Short Version, the Strengths and Difficulties Questionnaire, and a questionnaire that elicited their socio-demographic characteristics. The level of cognitive development of each sample child was assessed using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition. Pearson correlation analysis, linear regression analysis, and multivariable regression analysis were used to analyze the data.

RESULTS

The prevalence of mental health problems among sample children at preschool age was high (31.6%). If a caregiver practices an authoritative parenting style, it was found to be negatively associated with the mental health problems of their child. In contrast, a caregiver's authoritarian parenting style was positively associated with the mental health problems of their child. Compared to those in a subgroup of primary caregivers that used a combination of low authoritative and low authoritarian parenting style, primary caregivers that used a combination of high authoritarian and low authoritative or a combination of high authoritative and high authoritarian were found to have positive association with child health problems. A number of demographic characteristics were found to be associated with the adoption of different parenting styles.

CONCLUSION

Different parenting styles (including authoritative, authoritarian, and combination of authoritative and authoritarian) of the sample caregivers had different associations with the mental health problems of the sample children. Parenting programs that aim to improve the parenting styles (favoring authoritative parenting styles) should be promoted in an effort to improve the status of child mental health in rural China.

Cluster-specific associations between the gut microbiota and behavioral outcomes in preschool-aged children

BACKGROUND

The gut microbiota is recognized as a regulator of brain development and behavioral outcomes during childhood. Nonetheless, associations between the gut microbiota and behavior are often inconsistent among studies in humans, perhaps because many host-microbe relationships vary widely between individuals. This study aims to stratify children based on their gut microbiota composition (i.e., clusters) and to identify novel gut microbiome cluster-specific associations between the stool metabolomic pathways and child behavioral outcomes.

METHODS

Stool samples were collected from a community sample of 248 typically developing children (3-5 years). The gut microbiota was analyzed using 16S sequencing while LC-MS/MS was used for untargeted metabolomics. Parent-reported behavioral outcomes (i.e., Adaptive Skills, Internalizing, Externalizing, Behavioral Symptoms, Developmental Social Disorders) were assessed using the Behavior Assessment System for Children (BASC-2). Children were grouped based on their gut microbiota composition using the Dirichlet multinomial method, after which differences in the metabolome and behavioral outcomes were investigated.

RESULTS

Four different gut microbiota clusters were identified, where the cluster enriched in both Bacteroides and Bifidobacterium (Ba2) had the most distinct stool metabolome. The cluster characterized by high Bifidobacterium abundance (Bif), as well as cluster Ba2, were associated with lower Adaptive Skill scores and its subcomponent Social Skills. Cluster Ba2 also had significantly lower stool histidine to urocanate turnover, which in turn was associated with lower Social Skill scores in a cluster-dependent manner. Finally, cluster Ba2 had increased levels of compounds involved in Galactose metabolism (i.e., stachyose, raffinose, alpha-D-glucose), where alpha-D-glucose was associated with the Adaptive Skill subcomponent Daily Living scores (i.e., ability to perform basic everyday tasks) in a cluster-dependent manner.

CONCLUSIONS

These data show novel associations between the gut microbiota, its metabolites, and behavioral outcomes in typically developing preschool-aged children. Our results support the concept that cluster-based groupings could be used to develop more personalized interventions to support child behavioral outcomes. Video Abstract.

Childhood ADHD With and Without Co-occurring Internalizing/Externalizing Problems: Prospective Predictions of Change in Adolescent Academic and Social Functioning

OBJECTIVE

Internalizing and externalizing problems predict poor academic and social outcomes. However, ADHD co-occurs with internalizing and externalizing problems and is itself a risk factor, thus preventing precise inferences. This study evaluated childhood anxiety, depression, and aggression as predictors of change in adolescent academic and social outcomes, including moderation by childhood ADHD.

METHODS

182 ethnically-diverse 5- to 11-year-old youth with (54.7%) and without (45.3%) ADHD completed a separate baseline and 6- to 7-year prospective follow-up assessment, consisting of parallel measures across youth psychopathology, academic functioning (i.e., academic achievement, school competence), and friendship quality domains.

RESULTS

Whereas childhood ADHD inversely predicted academic competence, depression and aggression uniquely predicted worsening friendship quality. Interestingly, anxiety was unrelated to change in academic and friendship outcomes; similarly, neither ADHD, depression, nor aggression predicted change in objectively-measured academic achievement from a standardized assessment.

CONCLUSION

Implications for intervention and prevention are considered, including school-based approaches, within a developmental psychopathology framework.

Longitudinal trajectories of sickness absence among young adults with a history of depression and anxiety symptoms in Sweden

BACKGROUND

Depression and anxiety are associated with increased risk of sickness absence (SA), yet the developmental patterns of SA remain unclear. We aimed to identify trajectories of SA in young adults with depression and/or anxiety, accounting for sociodemographic and occupational factors.

METHODS

Longitudinal study of 1445 twin individuals with elevated depressive/anxiety symptoms in late adolescence or young adulthood (age range: 19-30), assessed in Swedish surveys completed in 2005. Through linkage to nationwide registries, individuals were prospectively followed from 2006 to 2018. The outcome included consecutive annual days of SA, which were analyzed using group-based trajectory modeling. Multinomial logistic regression estimating odds ratios (OR) with 95 % confidence intervals (CI) was used to examine associations of age, sex, and educational level with the resulting SA trajectories.

RESULTS

Four distinct SA trajectories were identified in the total sample: 'high-increasing' (6 %), 'low-increasing' (12 %), 'high-decreasing' (13 %), and 'low-constant' (69 %). Increasing age was associated with higher odds of belonging to the low-increasing trajectory (OR = 1.07, 95 % CI = 1.02-1.12). Women had higher odds of belonging to the low-increasing trajectory (OR = 1.67, 95 % CI = 1.10-2.53), compared with men. Higher education was associated with lower odds of belonging to high-increasing (OR = 0.34, 95 % CI = 0.22-0.54) and high-decreasing (OR = 0.59, 95 % CI = 0.43-0.81) trajectories, compared with lower education. Few differences were observed in analyses stratified by occupational sector.

LIMITATIONS

Information on potential confounders (e.g., psychiatric comorbidity, work-environment factors) was not available.

CONCLUSIONS

Among young adults with prior depression/anxiety, close to every fifth showed rising SA trajectories over time. This calls for targeted strategies to improve public mental health already at young ages.

Impact of mental disorders during education on work participation: a register-based longitudinal study on young adults with 10 years follow-up

BACKGROUND

Mental disorders are a leading cause of disability and a major threat to work participation in young adults. This register-based longitudinal study aims to investigate the influence of mental disorders on entering and exiting paid employment among young graduates and to explore differences across socioeconomic groups.

METHODS

Register information on sociodemographics (age, sex, migration background) and employment status of 2 346 393 young adults who graduated from secondary vocational (n=1 004 395) and higher vocational education or university (n=1 341 998) in the period 2010-2019 was provided by Statistics Netherlands. This information was enriched with register information on the prescription of nervous system medication for mental disorders in the year before graduation as a proxy for having a mental disorder. Cox proportional hazards regression models were used to estimate the influence of mental disorders on (A) entering paid employment among all graduates and (B) exiting from paid employment among graduates who had entered paid employment.

RESULTS

Individuals with mental disorders were less likely to enter (HR 0.69-0.70) and more likely to exit paid employment (HR 1.41-1.42). Individuals using antipsychotics were the least likely to enter (HR 0.44) and the most likely to exit paid employment (HR 1.82-1.91), followed by those using hypnotics and sedatives. The association between mental disorders and work participation was found across socioeconomic subgroups (ie, educational level, sex and migration background).

DISCUSSION

Young adults with mental disorders are less likely to enter and maintain paid employment. These results ask for prevention of mental disorders and for a more inclusive labour market.

Does social disadvantage persist over generations due to an uneven distribution of mental health diagnoses? A longitudinal investigation of Finnish register data

Social disadvantages persist over generations, while the mechanisms behind the intergenerational transmission are not well understood. To fill this gap, first, we examine to what degree being diagnosed with a mental health disorder in adolescence mediate the transmission of social disadvantage. Second, we investigate whether the role of mental health varies for different outcomes. Third, we examine differences between disorder groups and gender. We exploited register data on the full Finnish population including information on mental health diagnoses (MHD) based on ICD-10 classification recorded in public specialized health care. As socioeconomic outcomes, we used offspring's (N = 511,835) records for low educational attainment, unemployment, and social assistance dependency in early adulthood. In addition to linear probability models, the g-computation method was used to simulate the degree to which reducing mental health inequalities in adolescence could narrow the differences between children of different family backgrounds. Our results show that adolescents with MHD had a higher likelihood of experiencing social disadvantage as young adults even after accounting for parental socioeconomic status and alternative health pathways. The counterfactual analysis indicated that the proportion mediated by unevenly distributed MHD was with 7.5% highest for social assistance followed by 4.2% for education and 3.2% for unemployment. The effect of mental health was modified by gender yet direction and strength varied across methods and externalizing behaviors mattered more for the intergenerational persistence than internalizing behaviors. Hypothetically reducing MHD to the level of families with high socioeconomic status might indeed lower part of the intergenerational transmission of social assistance dependency but to lesser degree of unemployment and low educational attainment. We demonstrate the need of support and services for those with MHD, especially among socially disadvantaged groups. However, social disadvantage should not be overly medicalized as family background has an important independent effect on offspring's socioeconimic outcomes.

Distinct brain network features predict internalizing and externalizing traits in children and adults

Internalizing and externalizing traits are two distinct classes of behaviors in psychiatry. However, whether shared or unique brain network features predict internalizing and externalizing behaviors in children and adults remain poorly understood. Using a sample of 2262 children from the Adolescent Brain Cognitive Development (ABCD) study and 752 adults from the Human Connectome Project (HCP), we show that network features predicting internalizing and externalizing behavior are, at least in part, dissociable in children, but not in adults. In ABCD children, traits within internalizing and externalizing behavioral categories are predicted by more similar network features concatenated across task and resting states than those between different categories. We did not observe this pattern in HCP adults. Distinct network features predict internalizing and externalizing behaviors in ABCD children and HCP adults. These data reveal shared and unique brain network features accounting for individual variation within broad internalizing and externalizing categories across developmental stages.

Associations of Internalizing and Externalizing Problems in Childhood and Adolescence With Adult Labor Market Marginalization

Importance

Mental health problems in early life are associated with labor market marginalization, especially in youths with persistent internalizing and externalizing problems. However, previous research has not adjusted for familial (genetic and shared environmental) factors.

Objective

To examine associations of early-life internalizing and externalizing problems with adulthood unemployment and work disability, adjusting for familial factors.

Design, Setting, and Participants

This population-based prospective cohort study included Swedish twins who were born in 1985-1986 and surveyed at 4 consecutive waves across childhood and adolescence until 2005. Through linkage to nationwide registries, participants were followed up from 2006 to 2018. Data analyses were conducted between September 2022 and April 2023.

Exposures

Internalizing and externalizing problems, assessed with the Child Behavior Checklist. Participants were differentiated regarding duration of internalizing and externalizing problems (persistent, episodic, and noncases).

Main Outcomes and Measures

Unemployment (180 days or more of being unemployed) and work disability (60 days or more of being sickness absent or disability pensioned) during follow-up. Cox proportional hazards regression models were calculated to obtain cause-specific hazard ratios (HRs) with 95% CIs in the whole cohort and exposure-discordant twin pairs.

Results

Of 2845 participants, 1464 (51.5%) were female. Incident unemployment was experienced by 944 (33.2%) and incident work disability by 522 (18.3%) participants. Compared with noncases, persistent internalizing problems were associated with unemployment (HR, 1.56; 95% CI, 1.27-1.92) and work disability (HR, 2.32; 95% CI, 1.80-2.99). Similarly, compared with noncases, persistent externalizing problems were associated with unemployment (HR, 1.87; 95% CI, 1.55-2.26) and work disability (HR, 2.38; 95% CI, 1.87-3.03). Persistent cases had overall higher risks of adverse outcomes than episodic cases. After adjustment for familial factors, associations with unemployment were no longer statistically significant, whereas associations with work disability remained or were only slightly reduced.

Conclusions and Relevance

In this cohort study of young Swedish twins, familial factors explained the associations between early-life persistent internalizing and externalizing problems and unemployment; such factors were comparatively less important for the association with work disability. This suggests nonshared environmental factors may be important for the risk of future work disability among young individuals with persistent internalizing and externalizing problems.

Maternal psychological functioning mediates the association between infant behavior and subsequent child psychological functioning

Symptoms of psychopathology that onset during childhood are often more severe, chronic, and difficult to treat than symptoms that first appear later in life. Maternal psychological symptoms are associated with the development of psychological symptoms in children. However, less research focuses on whether children's behaviors may presage maternal psychological difficulties that, in turn, contribute to the child's own psychological functioning. Identifying psychological difficulties in families and intervening in early life may lower risk for intergenerational transmission of subsequent psychological symptoms. Even at non-clinical or normative levels, exploring transactional models of parent-child behavior and psychological functioning may provide insight into the development of later psychological difficulties or symptoms within families. Thus, the current study examined whether difficult infant behavior (e.g., fussiness, unpredictability) is associated with future maternal psychological difficulties and subsequently, the child's own psychological functioning in early childhood. The current sample includes 847 dyads from a multi-wave birth cohort in England ('Born in Bradford'), who identified as predominantly non-White (62.2%) and socioeconomically diverse. Mothers reported on their child's behaviors at 6 months, their own psychological functioning during pregnancy and at 18 months postpartum, and their child's psychological functioning at age 3. Results of a mediation model revealed that the association between infant behavior at 6 months and child psychological functioning at 3 years is partially explained by maternal psychological functioning at 18 months, even after accounting for psychological difficulties during pregnancy, maternal age at birth, child sex, family income, and ethnicity. Post-hoc exploratory analyses revealed that the association between infant behavior, maternal psychological functioning, and subsequent child psychological functioning was significant for Pakistani British families but not White British families. These findings provide preliminary evidence that infant behaviors (e.g., temperament) may presage future maternal psychological difficulties and subsequent child psychological functioning, above and beyond previous maternal psychological functioning. Importantly, these results highlight infant behavior as a potential catalyst for later psychological difficulties within families.

Interaction between isolated maternal hypothyroxinemia and pregnancy-related anxiety on preschooler's internalizing and externalizing problems: A birth cohort study

BACKGROUND

Isolated maternal hypothyroxinemia (IMH) and pregnancy-related anxiety may increase the risk of offspring's emotional and behavioral problems, but little is known about their potential interactive effect on preschoolers' internalizing and externalizing problems.

METHODS

We conducted a large prospective cohort study in Ma'anshan Maternal and Child Health Hospital between May 2013 and September 2014. There were a total of 1372 mother-child pairs from the Ma'anshan birth cohort (MABC) included in this study. IMH was defined as the thyroid-stimulating hormone (TSH) level within the normal reference range (2.5-97.5th percentile) and the free thyroxine (FT₄) level below the 2.5th percentile, and negative TPOAb. The pregnancy-related anxiety questionnaire (PRAQ) was used to assess women's pregnancy-related anxiety status in the first (1-13 weeks), second (14-27 weeks) and third (after 28 weeks) trimesters of pregnancy. The Achenbach Child Behavior Checklist (CBCL/1.5-5) was used to assess preschoolers' internalizing and externalizing problems.

RESULTS

Preschoolers born of mothers with IMH and anxiety had an increased risk of anxious/depressed (OR = 6.40, 95% CI 1.89-21.68), somatic complaints (OR = 2.69, 95% CI 1.01-7.20), attention problems (OR = 2.95, 95% CI 1.00-8.69) and total problems (OR = 3.40, 95% CI 1.60-7.21). Particularly, mothers with IMH and anxiety was associated with an increased risk of preschool girls' anxious/depressed (OR = 8.14, 95% CI 1.74-38.08), withdrawn (OR = 7.03, 95% CI 2.25-21.92), internalizing problems (OR = 2.66, 95% CI 1.00-7.08), and total problems (OR = 5.50, 95% CI 2.00-15.10).

CONCLUSIONS

IMH and pregnancy-related anxiety during pregnancy may synergistically increase the risk of internalizing and externalizing problems in preschooler children. This interaction is distinct in internalizing problems of preschool girls.

Maternal preconception circulating blood biomarker mixtures, child behavioural symptom scores and the potential mediating role of neonatal brain microstructure: the S-PRESTO cohort

Human brain development starts in the embryonic period. Maternal preconception nutrition and nutrient availability to the embryo may influence brain development at this critical period following conception and early cellular differentiation, thereby affecting offspring neurodevelopmental and behavioural disorder risk. However, studying this is challenging due to difficulties in characterizing preconception nutritional status and few studies have objective neurodevelopmental imaging measures in children. We investigated the associations of maternal preconception circulating blood nutrient-related biomarker mixtures (~15 weeks before conception) with child behavioural symptoms (Child Behaviour Checklist (CBCL), aged 3 years) within the Singapore Preconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO) study. The CBCL preschool form evaluates child behaviours based on syndrome scales and Diagnostic and Statistical Manual of Mental Disorders (DSM) oriented scales. These scales consist of internalizing problems, externalizing problems, anxiety problems, pervasive developmental problems, oppositional defiant, etc. We applied data-driven clustering and a method for modelling mixtures (Bayesian kernel machine regression, BKMR) to account for complex, non-linear dependencies between 67 biomarkers. We used effect decomposition analyses to explore the potential mediating role of neonatal (week 1) brain microstructure, specifically orientation dispersion indices (ODI) of 49 cortical and subcortical grey matter regions. We found that higher levels of a nutrient cluster including thiamine, thiamine monophosphate (TMP), pyridoxal phosphate, pyridoxic acid, and pyridoxal were associated with a higher CBCL score for internalizing problems (posterior inclusion probability (PIP) = 0.768). Specifically, thiamine independently influenced CBCL (Conditional PIP = 0.775). Higher maternal preconception thiamine level was also associated with a lower right subthalamic nucleus ODI (P-value = 0.01) while a lower right subthalamic nucleus ODI was associated with higher CBCL scores for multiple domains (P-value < 0.05). One potential mechanism is the suboptimal metabolism of free thiamine to active vitamin B1, but additional follow-up and replication studies in other cohorts are needed.

Internalizing and Externalizing Disorder Levels among Adolescents: Data from Poland

This article concerns internalizing and externalizing behaviors among Polish adolescents attending primary schools in a medium-sized city in Poland. The aim of the study was to examine the levels of select problem behaviors (i.e., depression, withdrawal, somatic complaints, aggressive behaviors, delinquent behaviors, thought problems, and internalizing and externalizing disorders) in early adolescence. Another important aim was to establish the ranges of the norm and deviation which would indicate the need for intervention aimed at internalizing and externalizing disorders in the sample. The relationships between variables such as age, gender, and school achievement (grade average) and the groups of problem behaviors and externalizing and internalizing disorders were also examined. To diagnose the occurrence of internalizing and externalizing behaviors, a sample of 550 students (55.3% girls, 46.7% boys) were measured using the Youth Self-Report (YSR) questionnaire. The results showed statistically significant differences in internalizing and externalizing behaviors between boys and girls. Girls achieved higher scores on most of the YSR scales, including internalizing and externalizing disorders, as well as on the total score. The student subgroup scores were also differentiated in terms of age and their average grades. The results also have practical implications; namely, the need for obligatory screening tests of students' emotional states; encouraging preventive measures in schools, including diagnosis and psychological support in the context of depression; monitoring aggressive behaviors and social problems, both in boys and girls; and implementing universal, selective, and indicated prevention through complex, empirically validated educational-therapeutic programs.

Behavioural and emotional comorbidities in school-aged children with neurological conditions in Kilifi, Kenya, and their long-term consequences

Background

Neurological conditions and mental health problems are common in children in low- and middle-income countries, but the risk factors and downstream impact of these problems on children with neurological conditions are not reported.

Objective

To determine the association of neurological conditions with behavioural and emotional problems in children, the prevalence and risk factors of behavioural and emotional problems, and long-term impact of these conditions.

Methods

Data on multiple neurological conditions and mental health problems were available for 1,616 children (aged 6–9 years) from Kilifi, Kenya. Neurological conditions were diagnosed using standardised tools and clinical examination. Behavioural and emotional problems assessed using Child Behaviour Questionnaire for Parents. Long-term outcomes were obtained from census data of the Kilifi Health and Demographic Surveillance System. Logistic and linear regression were used to measure associations.

Results

Mental health problems were higher in those with any neurological condition compared to those without (24% vs. 12%, p < 0.001). Cognitive (odds ratio (OR) = 2.39; 95% CI: 1.59–3.59), motor (OR = 3.17; 95% CI: 1.72–5.82), hearing (OR = 2.07; 95% CI:1.12–3.83) impairments, and epilepsy (OR = 4.18; 95% CI: 2.69–6.48), were associated with mental health problems. Prevalence of any mental health problem was 15%, with externalizing problems more common than internalizing problems (21% vs. 17%, p = 0.004). Longitudinal follow-up indicated that the disorders affected an individual’s future schooling (e.g. OR = 1.25; 95% CI: 0.14–1.46 following cognitive impairments), occupation (OR = 2.44; 95% CI: 1.09–5.44 following mental health problems), and access to household assets (OR = 2.78; 95% CI: 0.99–7.85 following epilepsy).

Conclusions

Neurological conditions in school-aged children in Kilifi are associated with mental health problems, and both disorders have long-term consequences. Preventive and therapeutic measures for these conditions are needed to improve outcomes of these children.

Maternal Pre-Pregnancy BMI and Gestational Weight Gain Modified the Association between Prenatal Depressive Symptoms and Toddler's Emotional and Behavioral Problems: A Prospective Cohort Study

Background: Maternal prenatal depressive symptoms and abnormal pre-pregnancy BMI have been scarcely reported to play interactive effects on child health. In this prospective cohort, we aimed to examine the interactive effects of maternal prenatal depressive symptoms and pre-pregnancy BMI as well as gestational weight gain (GWG) on offspring emotional and behavioral problems (EPBs). Methods: The study samples comprised 1216 mother−child pairs from Shanghai Maternal−Child Pairs Cohort recruited from 2016 to 2018. Maternal pre-pregnancy BMI and GWG were obtained from medical records, and maternal depressive symptoms were assessed via the Center for Epidemiological Studies Depression Scale (CES-D) at 32−36 gestational weeks. The child completed the behavioral measurement via the Strengths and Difficulties Questionnaire (SDQ) at 24 months postpartum. Results: There were 12.01% and 38.65% women with prenatal depressive symptoms and sub-threshold depressive symptoms during late pregnancy. Both maternal depressive symptoms and prenatal sub-threshold depressive symptoms were associated with higher internalizing (OR = 1.69, 95% CI, 1.05−2.72; OR = 1.48, 95% CI, 1.06−2.07) and externalizing (OR = 2.06, 95% CI, 1.30−3.25; OR = 1.42, 95% CI, 1.02−1.99) problems in children. Maternal pre-pregnancy BMI and GWG modified the association between prenatal depressive symptoms and child externalizing or total difficulties problems (p < 0.10 for interaction). Among the overweight/obese pregnant women, maternal prenatal depressive symptoms were associated with a higher risk of externalizing problems (OR = 2.75, 95% CI, 1.06−7.11) in children. Among the women who gained inadequate GWG, maternal prenatal sub-threshold depressive symptoms were associated with 2.85-fold (95% CI 1.48−5.48) risks for child externalizing problems, and maternal depressive symptoms were associated with higher externalizing and total difficulties problems (OR = 4.87, 95% CI, 2.03−11.70 and OR = 2.94, 95% CI, 1.28−6.74, respectively), but these associations were not significant in the appropriate or excessive GWG group. Conclusions: Both maternal prenatal sub-threshold depressive symptoms and depressive symptoms increased the risks of child internalizing and externalizing problems at 24 months of age, while the effects on child externalizing problems were stronger among overweight/obese or inadequate GWG pregnant women. Our study highlights the importance of simultaneously controlling the weight of pregnant women before and throughout pregnancy and prompting mental health in pregnant women, which might benefit their offspring’s EBPs.

Problem Behaviors of Adolescents: The Role of Family Socioeconomic Status, Parental Educational Expectations, and Adolescents' Confidence in the Future

The comprehensive theoretical model of problem behaviors proposes that family socioeconomic status is one of the factors affecting adolescent problem behaviors. The purpose of this study is to further explore the mechanism of the influence of family socioeconomic status on adolescent problem behaviors based on the framework of the comprehensive theoretical model of problem behaviors. Further, it is to discover more protective or risk factors affecting adolescent problem behaviors, so as to provide theoretical guidance for the prevention of and intervention in adolescent problem behaviors. This study used data from the 2014-2015 academic year of the China Education Panel Survey (CEPS) conducted by the China survey and data center at the Renmin University of China. A national representative sample of 6888 junior high school students was selected. Among them, 3342 (48.5%) were girls and 3546 (51.5%) were boys with an average age of 14.50 years (SD = 0.68 years). The results revealed that parental educational expectations and adolescents' confidence in the future played a contributory mediating role in the association between family socioeconomic status and adolescents' problem behaviors. Both parental educational expectations and adolescents' confidence in the future are protective factors against adolescents' problem behaviors and enhancing these factors can decrease the likelihood of adolescents' engagement in problem behaviors.

Co-occurrence, stability and manifestation of child and adolescent mental health problems: a latent transition analysis

Background

Complex constellations of socio-emotional and behavioural problems (i.e., mental health problems) in childhood and adolescence are common and heighten the risk for subsequent personality, anxiety and mood disorders in adulthood. Aims of this study included the examination of patterns of mental health problems (e.g., externalizing-internalizing co-occurrence) and their transitions to reported mental disorders by using a longitudinal person-centered approach (latent class and latent transition analysis).

Methods

The sample consisted of 1255 children and adolescents (51.7% female, mean age = 12.3 years, age range 8–26 years) from three time points of the comprehensive mental health and wellbeing BELLA study. Children and their parents completed the German SDQ (Strength and Difficulties Questionnaire, Goodman, 1997) and reported on diagnoses of ADHD, depression, and anxiety.

Results

Latent class analysis identified a normative class, an emotional problem class, and a multiple problem class. According to latent transition analysis, the majority of the sample (91.6%) did not change latent class membership over time; 14.7% of individuals showed a persistent pattern of mental health problems. Diagnoses of mental disorders were more likely to be reported by individuals in the emotional problem or multiple problem class.

Conclusions

Results highlight the need for early prevention of mental health problems to avoid accumulation and manifestation in the transition to adolescence and young adulthood.

Sickness absence among young employees in private and public sectors with a history of depression and anxiety

The aim was to investigate occurrence and duration of sickness absence (SA) among young employees with previous depression/anxiety in private and public sectors. This population-based prospective study included 11,519 Swedish twin individuals of age 19-29 years that were followed regarding SA during 2006-2016. Data on previous depression/anxiety came from two screening surveys in 2005. Data on SA and employment sector were received from national registries. Descriptive statistics and logistic regression were used, also controlling for familial factors. Proportion of employees with SA was significantly higher among those with, as compared to those without, previous depression/anxiety, regardless the employment sector. Individuals with previous depression/anxiety had increased risk for future SA, in both private (OR 2.25, 95% CI 1.90-2.66) and public sectors (OR 2.10, 95% CI 1.73-2.54). Familial factors played a role in the association among employees in the private sector. A higher proportion of long-term SA was observed among employees with previous depression/anxiety in the private as compared to the public sector. To conclude, previous depression/anxiety tends to increase risk for SA among young employees in both employment sectors, whereas long-term SA seemed to be more prevalent among those in the private as compared to the public sector.

Sustainable Working Life Patterns in a Swedish Twin Cohort: Age-Related Sequences of Sickness Absence, Disability Pension, Unemployment, and Premature Death during Working Life

We aimed to investigate sustainable working life via age-related sequences of sickness absence (SA), disability pension (DP), unemployment (UE), premature death, and the influence of individual characteristics, accounting for familial confounding. The sample included monozygotic (MZ) and dizygotic (DZ) same-sexed twin pairs with register data (n = 47,450) that were followed for 10 years in four age cohorts: 26-35 (n = 9892), 36-45 (n = 10,620), 46-55 (n = 12,964) and 56-65 (n = 13,974). A sequence analysis was done in a 7-element state space: 1. "Sustainable working life": SA/DP 0-30 days and UE 0-90 days; 2. "Unemployment >90 days": SA/DP 0-30 days and UE > 90 days; 3. "Moderate SA/DP": SA/DP 30-180 days; 4. "Almost full year of SA/DP": SA/DP 180-365 days; 5. "Full year of SA/DP": SA/DP ≥ 365 days; 6. Death; 7. Old-age pension. The largest cluster had a sustainable working life and never experienced states 2-6 (34-59%). Higher education and being married predicted a lower likelihood of experiencing states 2-6. The MZ twin pairs (vs. DZ) were more often in the same cluster suggesting the role of genetic factors. To conclude, the sustainable working life was the largest cluster group. Few individuals had prolonged periods of interruptions of sustainable working life meriting actions, especially in early adulthood for interventions to support workability.

Associations between neighborhood built, social, or toxicant conditions and child externalizing behaviors in the Detroit metro area: a cross-sectional study of the neighborhood ‘exposome’

Background

The specific ‘active ingredients’ through which neighborhood disadvantage increases risk for child psychopathology remains unclear, in large part because research to date has nearly always focused on poverty to the exclusion of other neighborhood domains. The objective of this study was to evaluate whether currently assessed neighborhood built, social, or toxicant conditions were associated with child externalizing psychopathology outcomes separately, and in a combined model, using data from the Detroit-metro county area.

Methods

We conducted principal components analyses for built, social, or toxicant conditions. Next, we fitted separate multiple regression models for each of the child externalizing psychopathology measures (oppositional defiant and conduct problems) as a function of built, social, or toxicant components.

Results

We found that built features (more non-profits, churches, and alcohol outlets, and less agriculture and vacant properties) were associated with conduct problems, while toxicant conditions (high percent industrial, toxins released and number of pre-1978 structures) were associated with oppositional defiance problems. There was no significant association between greenspace or social conditions and child externalizing outcomes. When examined simultaneously, only the significant independent association between built conditions and conduct problems remained.

Conclusions

Built, social, and toxicant neighborhood conditions are not interchangeable aspects of a given neighborhood. What’s more, built features are uniquely associated with child externalizing outcomes independently of other neighborhood characteristics. Future research should consider how changes in the built conditions of the neighborhood (e.g., development, decay) serve to shape child externalizing behaviors, with a focus on identifying potentially actionable elements.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13442-z.

A person-centered analysis of emotional-behavioral functioning profiles in adolescents: Associations with teacher autonomy support and growth mindset

Anchored in the socio-ecological framework, the current study examined the association of teacher autonomy support with emotional-behavioral functioning profiles using a person-centered approach and investigated whether growth mindset and adolescents’ gender would moderate this association. To achieve these research objectives, this study involved 1741 adolescents (54.1% girls; Mage = 12.62; SD = 1.50) who were uniformly instructed to fill in a set of self-report questionnaires. Results based on latent profile analysis revealed four emotional-behavioral functioning profiles: primarily externalizing (6.2%), comorbid (32.9%), well-adjusted (53.7%), and high-risk (7.2%). Adolescents with high teacher autonomy support were more likely to be group members of the well-adjusted profile than the remaining three emotional-behavioral functioning profiles. Moreover, interaction analyses demonstrated that girls benefited more when teacher autonomy support and growth mindset were congruently high, whereas boys did not. The current findings suggest that teachers should be equipped with sufficient skills and training to maintain an autonomy-supportive classroom climate. Meanwhile, growth mindset intervention may develop into an integral part of the school’s activities to facilitate adolescents’ optimal emotional-behavioral functions, but distinctly gendered pathways for these activities should be carefully considered.

Family, personal, parental correlates and behavior disturbances in school-aged boys with attention-deficit/hyperactivity disorder (ADHD): a cross-sectional study

BACKGROUND

To evaluate the relationship among family, personal, parental correlates, and behavioral disturbances in boys with attention-deficit/hyperactivity disorder (ADHD).

METHODS

We performed a hospital-based cross-sectional study. School-aged boys who first visited the hospital between 2000 and 2011 with ADHD were identified. Through medical records review, demographic information, family characteristics, personal characteristics, parental characteristics, and the Child Behavior Checklist (CBCL) collected during the first outpatient visit were retrieved. A T-score higher than 63 in the internalizing or externalizing subscale of the CBCL indicated severe behavioral disturbances in each domain. Multivariable logistic regression was used to evaluate the relationship between the correlates and behavioral disturbances. Eligible patients were further classified into groups without behavioral disturbance, with either only severe internalizing or only severe externalizing behaviors, or with both behaviors. Multivariable ordinal logistic regression was used to investigate the association between the correlates and the number of types of behavioral disturbances.

RESULTS

A total of 1855 boys with ADHD were included. In the multivariable logistic regression, family factors, including being first-born, living in a family not with both parents, and family history of mental disorder, were associated with severe internalizing and externalizing behaviors. Personal factors, including prenatal complications, perinatal complications, and medical and psychiatric comorbidities, were associated with severe internalizing behaviors, but only prenatal complications and medical comorbidities were associated with severe externalizing behaviors. Parental factors were only associated with severe externalizing behaviors. A higher paternal education level had a protective effect, but younger motherhood increased the risk. In ordinal logistic regression, these factors were also associated with more types of behavioral disturbances.

CONCLUSIONS

Multiple factors are related to behavioral disturbances in ADHD. Our study reported the association among family, personal, parental factors, severe internalizing behavior, severe externalizing behavior, and number of behavioral disturbances in boys with ADHD. However, the impacts differed as the behavior phenotypes varied. Further research is needed to better understand the heterogeneity of ADHD behavior.

Internalizing Behavior Problems Among the Left-Behind Children of the Hui Nationality in Rural China: A Cross-Sectional Study

Background

The internalizing behavior problems (IBPs) of left-behind children (LBC) due to parental migration are a widespread public health concern in China. A previous study showed that the detection rate of behavioral problems in the Hui was far higher than in the LBC of the Han nationality. However, to date, limited research has focused on IBPs in Chinese LBC of the Hui nationality. The aims of this present study are to explore the prevalence of IBPs and the influencing factors among the Hui LBC in the rural areas of China.

Methods

A cross-sectional study was conducted among school students from the southern rural areas in Ningxia, China (2012–2013). The caregivers or parents assessed IBPs using Achenbach’s Child Behavior Checklist for parents. The children completed the Egma Minnen av Bardndosnauppforstran, Junior Eysenck Personality Questionnaire and Piers–Harris Children’s Self-concept Scale. Data on 383 Hui LBC aged 6–16 y were included in this study. Multivariate logistic regression analysis was used to examine the relationships between the independent variables and children’s internalizing behaviors.

Results

Among the Hui population, the prevalence of IBPs in LBC and non-left-behind children (non-LBC) was 21.67% (83 of 383) and 18.18% (104 of 572), respectively, with no significant difference between these two groups (χ² = 1.77 and P = 0.18). However, among males of the Hui population, the prevalence of IBPs in LBC was 22.16%, which is significantly higher than in non-LBC (14.07%; χ² = 5.07; and P = 0.02). By controlling for gender and age, the multivariate logistic regression analysis showed that a mother highly favoring the subject (odds ratio [OR] = 2.70), average levels of neuroticism (OR = 9.01), and high levels of neuroticism (OR = 8.44) were risk factors for IBPs in Hui LBC.

Conclusion

Our findings suggest that IBPs among male LBC of the Hui nationality in rural China were positively related to parental migration. Positive measures should be taken to prevent IBPs of male LBC of the Hui nationality in rural China in terms of personality development and parental childrearing patterns.

Associations Between the Gut Microbiota and Internalizing Behaviors in Preschool Children

OBJECTIVE

Emerging evidence points toward a connection between mental health and the gut microbiota and its metabolites (e.g., short-chain fatty acids). It is unknown whether the gut microbiota is associated with the development of mental health problems (e.g., internalizing or externalizing behaviors) in preschool children. The objective of this study was to evaluate associations between the gut microbiota and internalizing and externalizing behaviors in preschool-aged children.

METHODS

A community sample of 248 typically developing children (3-5 years of age) provided a stool sample for gut microbiota and SCFA analysis. Parents reported child internalizing and externalizing behaviors using the Child Behavior Checklist. Associations between child behaviors and gut microbiota measures were analyzed using Spearman correlations followed by an adjustment for multiple testing, with subanalysis conducted in children clinically "at risk" for behavioral problems compared with those who were not.

RESULTS

There was a correlation between Shannon alpha diversity with internalizing behaviors (rs = -0.134, p = .035) and its subscale somatic complaints (rs = -0.144, p = .023). In addition, children clinically "at risk" for internalizing problems had decreased alpha diversity (U = 551, p = .017). Internalizing behaviors correlated with valerate and isobutyrate (rs = -0.147, p = .021; rs = -0.140, p = .028, respectively). Furthermore the somatic complaints subscale additionally correlated with acetate and butyrate (rs = -0.219, p = .001; rs = -0.241, p < .001, respectively). These findings were also present in children "at risk" for internalizing problems (U = 569, p = .026; U = 571, p = .028) and somatic complaints (U = 164, p = .004; U = 145, p = .001).

CONCLUSIONS

These analyses reveal novel associations between internalizing behaviors and the gut microbiota in preschool children. Furthermore, a relationship between somatic complaints and acetate and butyrate was identified, indicating that interventions that increase SCFA production warrant future investigation.

The mediating role of anxiety/depression symptoms between adverse childhood experiences (ACEs) and somatic symptoms in adolescents

INTRODUCTION

This study examines the relationships among recent adverse childhood experiences (ACEs), somatic symptoms, and anxiety/depression symptoms during adolescence and whether anxiety/depression symptoms mediate the relationship between ACEs and somatic symptoms.

METHODS

Longitudinal prospective data from the Longitudinal Studies of Child Abuse and Neglect study of 1354 children and their primary caregivers in the United States was used in this study. A longitudinal cross-lagged path analysis among recent ACEs, anxiety/depression symptoms, and somatic symptoms at three points during adolescence (ages 12, 14, and 16 years) was conducted.

RESULTS

The sample was 51% female and 53% African American. The results indicated significant concurrent associations between recent ACEs and increased anxiety/depression symptoms at ages 12, 14, and 16 (β = .27, p < .001; β = .15, p < .001; β = .07, p < .05) and between anxiety/depression symptoms and increased somatic symptoms at ages 12, 14, and 16 years (β = .44, p < .001; β = .39, p < .001; β = .49, p < .001). Moreover, anxiety/depression symptoms significantly mediated the relationship between recent ACEs and concurrent somatic symptoms at ages 12, 14, and 16 years (β = .12, p < .001; β = .06, p < .001; β = .04, p < .05). However, there was no significant relationship between recent ACEs and somatic symptoms.

CONCLUSION

The findings suggest that anxiety/depression symptoms mediate the concurrent relationships between recent ACEs and somatic symptoms at ages 12, 14, and 16. Clinicians should consider assessing anxiety/depression symptoms and possible concurrent exposure to ACEs when caring for adolescents who present with somatic symptoms.

The timing and duration of depressive symptoms from adolescence to young adulthood and young adults' NEET status: the role of educational attainment

PURPOSE

Depressive symptoms are negatively associated with labour market outcomes but whether the timing and duration of depressive symptoms or educational attainment (EA) affect NEET (Neither in Employment, Education, nor Training) is unknown. Therefore, this study aims to examine the effects of timing and duration of depressive symptoms in adolescence and the moderating and mediating role of EA on NEET in young adulthood.

METHODS

Data were used from 1512 participants in the Vestliv Study, a Danish prospective cohort study. Depressive symptoms were measured at age 14, 18 and 21. EA at age 21 and NEET at age 23 were derived from national registers. Logistic regression analyses and a 4-way decomposition approach were applied.

RESULTS

Among boys, depressive symptoms at ages 14 and 21 increased the risk of NEET (OR 1.65, 95% CI 1.00-2.74 and OR 2.20, 95% CI 1.37-3.53). Among girls, this regarded depressive symptoms at ages 18 and 21 (OR 1.76, 95% CI 1.26-2.46 and OR 1.59, 95% CI 1.13-2.22). For the duration of depressive symptoms, among boys any depressive symptoms increased the risk of NEET. Among girls, only persistent depressive symptoms increased the risk of NEET. EA did not mediate or moderate the association between depressive symptoms and NEET.

CONCLUSION

The timing and duration of depressive symptoms in adolescence matter for the association with NEET in young adulthood, with a double burden for those with both depressive symptoms and low EA. The results emphasize the importance of support for those who experience depressive symptoms in the school-to-work transition.

Universal Screening in Positive School Mental Health Using the ASEBA Methodology for Teachers: A Pilot Epidemiological Study

School-based detection and intervention are critical components in ensuring positive mental health in children, with teachers playing an essential role in assessing students’ well-being. The current research aims to be a pilot epidemiological study on positive school mental health in Malaga, Spain, using the Achenbach System of Empirically Based Assessment (ASEBA). Data were collected in the COVID-19 pre-pandemic setting, using the Caregiver-Teacher Report Form (C-TRF) and the Teacher Report Form (TRF) in a sample of 420 children, who were between 5 and 8 years old at the time of the data collection. In 5-year-old children, the DSM-oriented scale with the highest clinical prevalence corresponds to attention deficit and hyperactivity problems (1.13%). In this same sub-sample, clinical levels of externalizing problems (4.52%) were non-significantly more common than internalizing conditions (1.69%). As for children between 6 and 8 years old, the DSM-oriented scale with the highest prevalence of clinical scores corresponds to anxiety problems (4.12%) and conduct problems (2.88%). Clinical levels of externalizing problems (9.47%) were non-significantly more prevalent than internalizing problems (6.58%). The results present 95% confidence intervals prevalence data in the general population and sex-differentiated descriptive statistics. The results are discussed according to their implication for school mental health.

Work functioning among young adults: the role of mental health problems from childhood to young adulthood

Objectives

Mental health problems (MHPs) during childhood and adolescence are negatively associated with having a paid job in young adulthood. Yet, little is known about how young adults function at work, that is, do they experience difficulties in meeting their job demands given their health state. This longitudinal study aims to examine the impact of MHPs from childhood to young adulthood on young adults’ work functioning (WF).

Methods

Data were used from 1004 participants in the TRacking Adolescents’ Individual Lives Survey, a Dutch prospective cohort study with 18-year follow-up. MHP trajectories, including 11, 13.5, 16, 19, 22 and 26 age points, were identified using growth mixture models. WF was assessed at age 29 with the Work Role Functioning Questionnaire 2.0 (WRFQ). Regression analyses were conducted to examine the association between MHP trajectories and WF.

Results

Young adults with high-stable trajectories of internalising and externalising problems reported lower WF (mean WRFQ scores of 70.5 and 70.7, respectively) than those with low-stable trajectories (78.4 and 77.2), that is, they experience difficulties in meeting the work demands for more than one work day per full-time work week. Young adults with moderate-stable or decreasing MHP trajectories reported lower WF scores compared with those with low-stable trajectories.

Conclusions

Both persistent high and elevated levels of MHPs from childhood to young adulthood are associated with lower WF scores in young adulthood compared with low-level MHPs. Occupational healthcare professionals should support young workers with a history of MHPs to optimise their work functioning.

Mapping Pathways by Which Genetic Risk Influences Adolescent Externalizing Behavior: The Interplay Between Externalizing Polygenic Risk Scores, Parental Knowledge, and Peer Substance Use

Genetic predispositions and environmental influences both play an important role in adolescent externalizing behavior; however, they are not always independent. To elucidate gene-environment interplay, we examined the interrelationships between externalizing polygenic risk scores, parental knowledge, and peer substance use in impacting adolescent externalizing behavior across two time-points in a high-risk longitudinal sample of 1,200 adolescents (764 European and 436 African ancestry; Mage = 12.99) from the Collaborative Study on the Genetics of Alcoholism. Results from multivariate path analysis indicated that externalizing polygenic scores were directly associated with adolescent externalizing behavior but also indirectly via peer substance use, in the European ancestry sample. No significant polygenic association nor indirect effects of genetic risk were observed in the African ancestry group, likely due to more limited power. Our findings underscore the importance of gene-environment interplay and suggest peer substance use may be a mechanism through which genetic risk influences adolescent externalizing behavior.

Maternal human capital accumulation and children's well-being

Research examining the intergenerational transmission of human capital is subject to two limitations. First, for the parental generation, most studies focus on formal education but fail to consider vocational training experience, which has more variation than formal educational attainment over the life course. Second, most studies have found consistent conclusions using income and occupation for the children's outcomes but have generated mixed findings regarding health and cognitive ability. This study aims to answer whether mothers' additional vocational training beyond formal education is beneficial to children's health and cognitive ability. Applying fixed-effects regression to the National Longitudinal Survey of Youth 1979 and the National Longitudinal Survey of Youth Child and Young Adults datasets, this study finds that mothers' human capital accumulation is positively associated with higher cognitive scores for both boys and girls, but does not significantly predict children's illnesses or behavior problems. These findings bear implications for policy aimed at mitigating the intergenerational cycles of disadvantages.

Sustainable Working Life in a Swedish Twin Cohort-A Definition Paper with Sample Overview

Background: A unified or consensus definition of “sustainable working life” remains lacking, although studies investigating risk factors for labour market exit are numerous. In this study, we aimed (1) to update the information and to explore a definition of “sustainable working life” via a systematic literature review and (2) to describe the working life trajectories via the prevalence of sickness absence (SA), disability pension (DP), and unemployment in a Swedish twin cohort to provide a sample overview in our Sustainable Working Life-project. Methods: A systematic literature review was conducted to explore the studies with the search phrase “sustainable working life” in PubMed, PsycInfo, and the Web of Science Database of Social Sciences in January 2021, resulting in a total of 51 references. A qualitative synthesis was performed for the definitions and the measures of “sustainable working life.” Based on the Swedish Twin project Of Disability pension and Sickness absence (STODS), the current dataset to address sustainable working life includes 108 280 twin individuals born between 1925 and 1990. Comprehensive register data until 2016 for unemployment, SA and DP were linked to all individuals. Using STODS, we analysed the annual prevalence of SA, DP, and unemployment as working life trajectories over time across education and age groups. Results: The reviewed 16 full articles described several distinct definitions for sustainable working life between 2007 and 2020 from various perspectives, i.e., considering workplaces or employees, the individual, organizational or enterprise level, and the society level. The definition of “sustainable working life” appearing most often was the swAge-model including a broad range of factors, e.g., health, physical/mental/psychosocial work environment, work motivation/satisfaction, and the family situation and leisure activities. Our dataset comprised of 81%–94% of individuals who did not meet SA, DP, or unemployment during the follow-up in 1994–2016, being indicative for “sustainable working life.” The annual prevalence across years had a decreasing trend of unemployment over time, whereas the prevalence of SA had more variation, with DP being rather stable. Both unemployment and DP had the highest prevalence among those with a lower level of education, whereas in SA, the differences in prevalence between education levels were minor. Unemployment was highest across the years in the youngest age group (18–27 years), the age group differences for SA were minor, and for DP, the oldest age group (58–65 years) had the highest prevalence. Conclusions: No consensus exists for a “sustainable working life,” hence meriting further studies, and we intend to contribute by utilising the STODS database for the Sustainable Working Life project. In the upcoming studies, the existing knowledge of available definitions and frameworks will be utilised. The dataset containing both register data and self-reports enables detailed follow-up for labour market participation for sustainable working life.

What's in a diagnosis: The effect of externalizing and internalizing students' behaviour on pre-service teachers' classroom management and interaction strategies

BACKGROUND

All over the word, classrooms are getting more and more diverse and teachers are required to effectively manage these classes even when students have special education needs (SEN).

AIMS

The study aimed to investigate classroom management strategies and interpersonal teacher behaviour in relation to students internalizing and externalizing behaviour, whereby we varied the diagnosis of special educational needs.

SAMPLE

Two hundred and fifty-four German pre-service teachers (143 female) with a mean age of 26.04 years participated in the study.

METHOD

Using an experimental between-subjects design, a fictitious student was described as exhibiting either internalizing or externalizing behaviour. Additionally, we varied whether the student was diagnosed as having SEN or not. The participants were asked to indicate which strategies they would apply and how they would interact with students.

RESULTS

Results showed that teacher interaction in response to both students with internalizing and externalizing behaviour approached ideal interpersonal teacher behaviour (i.e. high level of cooperativeness with certain level of dominance), whereas pre-service teachers applied all classroom management strategies to minimize effects of student behaviour on learning time. Although pre-service teachers adapted their responses based on type of behaviour, they only made allowances for internalizing behaviour while their response to externalizing behaviour did not vary much as a function of a SEN diagnosis.

CONCLUSIONS

Together, these findings highlight the importance of providing pre-service teachers with the pedagogical knowledge concerning effective classroom management and flexible use of strategies in response to diverse student needs in inclusive classrooms.

Does the timing and duration of mental health problems during childhood and adolescence matter for labour market participation of young adults?

Background

Little is known about the timing and duration of mental health problems (MHPs) on young adults’ labour market participation (LMP). This life-course study aims to examine whether and how the timing and duration of MHPs between childhood and young adulthood are associated with LMP in young adulthood.

Methods

Logistic regression analyses were performed with data from the Tracking Adolescents’ Individual Lives Survey (TRAILS), a Dutch prospective cohort study with 15-year follow-up (N=874). Internalising and externalising problems were measured by the Youth/Adult Self-Report at ages 11, 13, 16, 19 and 22. Labour market participation (having a paid job yes/no) was assessed at age 26.

Results

Internalising problems at all ages and externalising problems at age 13, 19 and 22 were associated with an increased risk of not having a paid job (internalising problems ORs ranging from 2.24, 95% CI 1.02 to 4.90 at age 11 to OR 6.58, CI 3.14 to 13.80 at age 22; externalising problems ORs from 2.84, CI 1.11 to 7.27 at age 13 to OR 6.36, CI 2.30 to 17.56 at age 22). Especially a long duration of internalising problems increased the risk of not having a paid job in young adulthood.

Conclusion

The duration of MHPs during childhood and adolescence is strongly associated with not having paid work in young adulthood. This emphasises the necessity of applying a life-course perspective when investigating the effect of MHPs on LMP. Early monitoring, mental healthcare and the (early) provision of employment support may improve young adult’s participation in the labour market.

Cumulated and most recent job control and risk of disability pension in the Danish Work Life Course Cohort (DaWCo)

BACKGROUND

Previous studies have found low job control to be associated with a higher risk of disability pension (DP). Most studies have measured job control only at one time-point, and there is a lack of knowledge regarding the role of exposure duration. This study examines the prospective association between job control and DP measuring exposure both cumulated throughout work life and most recent.

METHODS

We included 712 519 individuals (about 4.5 million person-years) from The Danish Work Life Course Cohort which follows young employees in Denmark from their entry into the labour market. Job control was assessed with a job exposure matrix and DP with register data on public transfer payments. We adjusted for several potential life course confounders, including physical demands at work and parental socioeconomic position and psychiatric and somatic diagnoses.

RESULTS

Employees in occupations with low job control had a higher risk of DP. There were effects of both cumulated and most recent job control when mutually adjusted. Fully adjusted hazard ratios (HRs) were 1.14 [95% confidence intervals (CIs) 1.11-1.17] and 1.15 (95% CI 1.02-1.29) for cumulated and most recent job control, respectively. Without mutual adjustment, estimates were 1.15 (95% CI 1.13-1.18) and 1.55 (95% CI 1.39-1.72) for cumulated and most recent low job control, respectively.

CONCLUSIONS

Low job control predicts a higher risk of DP, even after adjustment for physical demands at work. The results indicate both gradual and short-term effects of low job control on DP risk.

Outcomes of the grief and communication family support intervention on parent and child psychological health and communication

Parents and children risk developing psychological health problems following the death of a partner/parent and may need professional support. This study used the reliable change criterion and clinically significant change to examine the outcomes of the Grief and Communication Family Support Intervention, comprising three family meetings with a family therapist, among 10 parents and 14 children, using pre-post outcome scores. The results provided preliminary evidence that the Grief and Communication Family Support Intervention may improve self-esteem and reduce anxiety in some parents and may improve communication and reduce internalizing and externalizing problems in some children.

The relationship of emotion regulation and negative lability with socioemotional adjustment in institutionalized and non-institutionalized children

With this study, we aimed to investigate the contribution of emotion regulation and negative lability to socioemotional adjustment in institutionalized and non-institutionalized children. Ninety-two children aged 6 to 10 years (45 placed in residential care after abuse and 47 non-abused, living with their biological families) participated in this study. Emotion Regulation Questionnaire and Strengths and Difficulties Questionnaire were completed by the main caregivers of the institutions and by the elementary teacher, respectively, for the institutionalized and non-institutionalized groups. No differences were observed between institutionalized and non-institutionalized children in emotion regulation, negative lability, and socioemotional adjustment outcomes. Also, no sex and age effects were observed for both groups. Considering the institutionalized children, the length of institutionalization had a significant effect on negative lability, while no effects of the type of maltreatment on emotion regulation and negative lability were observed. Additionally, in institutionalized children, negative lability was negatively associated with peer relationship problems in socioemotional adjustment, whereas in the non-institutionalized children, no significant associations were verified between emotion regulation and negative lability with socioemotional adjustment outcomes. For institutionalized children, emotional lability seems to have a differential impact on specific maladaptive socioemotional outcomes, which emphasizes the importance of analysing these specific risk developmental pathways.

A protocol for a scoping review of equity measurement in mental health care for children and youth

BACKGROUND

Mental health (MH) problems are among the most important causes of morbidity and mortality for children and youth. Problems of lack of equity in child and youth MH services (CYMHS)-including, but not limited to, problems in inaccessibility and quality of services-are widespread. Characterizing the nature of equity in CYMHS is an ongoing challenge because the field lacks a consistent approach to conceptualizing equity. We will conduct a scoping review of how equity in MH services for children and youth has been defined, operationalized, and measured. Our objectives are to discover: (1) What conceptual definitions of equity are used by observational studies of CYMHS?; (2) What service characteristics of CYMHS care do indices of equity cover?; (3) What population dimensions have been used to operationalize equity?; (4) What statistical constructs have been used in indices that measure CYMHS equity?; and (5) What were the numerical values of those indices?

METHODS

The following databases will be searched: Medline, Embase, PsycINFO, Cochrane Controlled Register of Trials, CINAHL, EconLit, and Sociological Abstracts. Searches will be conducted from the date of inception to the end of the last full calendar year (December 2019). Studies will be included if they include an evaluation of a mental health service for children or youth (defined as those under 19 years of age) and which quantify variation in some aspect of child or youth mental health services (e.g., accessibility, volume, duration, or quality) as a function of socio-demographic and/or geographic variables. Study selection will occur over two stages. Stage one will select articles based on title and abstract using the liberal-accelerated method. Stage two will review the full texts of selected titles. Two reviewers will work independently on full-text reviewing, with each study screened twice using pre-specified eligibility criteria. One reviewer will chart study characteristics and indices to be verified by a second reviewer. Reviewers will resolve full-text screening and data extraction disagreements through discussion. Synthesis of the collected data will focus on compiling and mapping the types and characteristics of the indices used to evaluate MH services equity.

DISCUSSION

The planned, systematic scoping review will survey the literature regarding how equity in MH services for children and youth has been operationalized and help inform future studies of equity in CYMHS.

SYSTEMATIC REVIEW REGISTRATION

Open Science Foundation ID SYSR-D-19-00371, https://osf.io/58srv/ .

Neurocognitive predictors of treatment completion and daytime activities at follow-up in multiproblem young adults

Previous research has shown an association between cognitive control deficits and problematic behavior such as antisocial behavior and substance use, but little is known about the predictive value of cognitive control for treatment outcome. The current study tests whether selected markers of baseline cognitive control predict (1) treatment completion of a day treatment program involving a combination of approaches for multiproblem young adults and (2) daytime activities a year after the start of treatment, over and above psychological, social, and criminal characteristics. We assessed individual, neurobiological, and neurobehavioral measures, including functional brain activity during an inhibition task and two electroencephalographic measures of error processing in 127 male multiproblem young adults (age 18-27 years). We performed two hierarchical regression models to test the predictive power of cognitive control for treatment completion and daytime activities at follow-up. The overall models did not significantly predict treatment completion or daytime activities at follow-up. However, activity in the anterior cingulate cortex (ACC) during response inhibition, years of regular alcohol use, internalizing problems, and ethnicity were all significant individual predictors of daytime activity at follow-up. In conclusion, cognitive control could not predict treatment completion or daytime activities a year after the start of treatment over and above individual characteristics. However, results indicate a direct association between brain activity during response inhibition and participation in daytime activities, such as work or school, after treatment. As adequate baseline inhibitory control is associated with a positive outcome at follow-up, this suggests interventions targeting cognitive control might result in better outcomes at follow-up.

The Effects of Family Financial Stress and Primary Caregivers' Levels of Acculturation on Children's Emotional and Behavioral Problems among Humanitarian Refugees in Australia

The present study evaluated the application of the basic and extended (incorporated primary caregivers' levels of acculturation) Family Stress Model (FSM) to understand the effect of family financial stress and primary caregivers' levels of acculturation on children's emotional and behavioral problems among refugees in Australia. A total of 658 refugee children aged 5-17 and their primary caregivers (n = 410) from the third wave of a nationwide longitudinal project were included in this study. We used multilevel structural equation models with bootstrapping to test the indirect effects of family financial stress and caregivers' levels of acculturation (including English proficiency, self-sufficiency, social interaction, and self-identity) on children's emotional and behavioral problems through caregivers' psychological distress and parenting styles. The results showed that the extended FSM improved the model fit statistics, explaining 45.8% variation in children's emotional and behavioral problems. Family financial stress, caregivers' English proficiency, and self-identity had indirect effects on children's emotional and behavioral problems through caregivers' psychological distress and hostile parenting. The findings showed that interventions aimed at reducing caregivers' psychological distress and negative parenting could be effective in alleviating the adverse effects of family financial stress and caregivers' low levels of acculturation on refugee children's mental health.

The role of HPA-axis function during pregnancy in the intergenerational transmission of maternal adverse childhood experiences to child behavior problems

The current study aimed to understand the mediating and/or moderating role of prenatal hypothalamic-pituitary-adrenal (HPA) axis function in the association between maternal adverse childhood experiences (ACEs) and child internalizing and externalizing behavior problems at age 4. The influence of timing and child sex were also explored. Participants were 248 mother-child dyads enrolled in a prospective longitudinal cohort study (the Alberta Pregnancy Outcomes and Nutrition Study). Maternal ACEs were retrospectively assessed while maternal self-reported depression and diurnal salivary cortisol were assessed prospectively at 6-26 weeks gestation (T1) and 27-37 weeks gestation (T2). Maternal report of child internalizing and externalizing problems was assessed at 4 years (T3). Results revealed that there was a negative indirect association between maternal ACEs and child internalizing behavior via a higher maternal cortisol awakening response (CAR). Maternal diurnal cortisol slope moderated the association between maternal ACEs and child behavior problems. Some of these effects were dependent on child sex, such that higher ACEs and a flatter diurnal slope at T1 was associated with more internalizing behavior in female children and more externalizing behavior in male children. There were timing effects such that the mediating and moderating effects were strongest at T1.

Time-varying Effects of GABRG1 and Maladaptive Peer Behavior on Externalizing Behavior from Childhood to Adulthood: Testing Gene × Environment × Development Effects

Engagement in externalizing behavior is problematic. Deviant peer affiliation increases risk for externalizing behavior. Yet, peer effects vary across individuals and may differ across genes. This study determines gene × environment × development interactions as they apply to externalizing behavior from childhood to adulthood. A sample (n = 687; 68% male, 90% White) of youth from the Michigan Longitudinal Study was assessed from ages 10 to 25. Interactions between γ-amino butyric acid type A receptor γ1 subunit (GABRG1; rs7683876, rs13120165) and maladaptive peer behavior on externalizing behavior were examined using time-varying effect modeling. The findings indicate a sequential risk gradient in the influence of maladaptive peer behavior on externalizing behavior depending on the number of G alleles during childhood through adulthood. Individuals with the GG genotype are most vulnerable to maladaptive peer influences, which results in greater externalizing behavior during late childhood through early adulthood.

Adolescent-Reported Sleep/Wake Patterns in the Relationships Between Inhibitory Control and Internalizing and Externalizing Problems

OBJECTIVE

Youth with poorer inhibitory control are more likely to experience internalizing and externalizing problems, placing them at risk for poorer psychological, academic, and social functioning. Modifying inhibitory control is challenging; therefore, research is needed to identify alternative targets to reduce internalizing and externalizing problems in youth. Sleep/wake patterns may serve as alternative targets, given their relationships with poorer inhibitory control and greater internalizing and externalizing problems. This study examines the mediating role of sleep/wake patterns in the relationships between youth inhibitory control and internalizing and externalizing problems.

METHOD

One hundred fifty-five adolescent (ages 12-15 years) and parent dyads completed the Behavioral Rating Inventory of Executive Function, Pediatric Symptom Checklist, and Adolescent Sleep-Wake Scale, short version. Bootstrapped mediations examined indirect relationships between inhibitory control and internalizing and externalizing through sleep/wake patterns.

RESULTS

Analyses revealed that problematic sleep/wake patterns partially mediated the relationship between poorer inhibitory control and greater internalizing, explaining 19% of the variance in internalizing problems. In addition, problematic sleep/wake patterns partially mediated the relationship between poorer inhibitory control and greater externalizing, explaining 58% of the variance in externalizing problems.

CONCLUSION

The results suggest that sleep/wake patterns may be a mechanism through which deficits in inhibitory control increase youth risk for internalizing and externalizing problems. Because sleep/wake patterns are frequently modified through adoption of health behaviors conducive to good sleep, assessing for problematic patterns in adolescents who present with internalizing and externalizing problems may offer providers a relatively modifiable target to reduce the emotional and behavioral problems of youth with poorer inhibitory control abilities.

Antenatal determinants of early childhood talking delay and behavioural difficulties

The determinants of talking delay alone or its comorbidity with behavioural difficulties was examined in 5768 two-year-old members of the Growing Up in New Zealand longitudinal study. Using the MacArthur-Bates Communicative Development inventories and the total difficulties score from the preschool Strengths and Difficulties Questionnaire, a composite measure was created so that children were categorised as showing no language or behavioural concerns (72.5%), behavioural only difficulties (6.1%), language only difficulties (18.1%), and comorbid language and behavioural difficulties (3.3%). Analyses revealed that antenatal factors such as maternal perceived stress, inadequate folate intake, vitamin intake, alcohol consumption during the first trimester and maternal smoking all had a significant effect on child outcomes. In particular, low multivitamin intake and perceived stress during pregnancy were associated with coexisting language and behavioural difficulties. These findings support international research in showing that maternal factors during pregnancy are associated with developmental outcomes in the early childhood period, and demonstrate these associations within a NZ context. Interventions which address maternal stress management and health behaviours during pregnancy could be beneficial to offspring development.

Pathways from parental mental disorders to offspring's work disability due to depressive or anxiety disorders in early adulthood-The 1987 Finnish Birth Cohort

BACKGROUND

Parental mental disorders have been shown to predict offspring's mental health problems. We examined whether pathways from parental mental disorders to offspring's psychiatric work disability in early adulthood are mediated through offspring's mental disorders and social disadvantage in adolescence.

METHODS

Study population consisted of the 1987 Finnish Birth Cohort. Data on parents' psychiatric care or work disability due to mental diagnosis between 1987 and 2000 and the cohort participants' health and social factors between 2001 and 2005 were derived from administrative national registers. From 2006 through 2015, 52,182 cohort participants were followed for admittance of psychiatric work disability due to depressive or anxiety disorders. First, we applied a pathway analysis to examine the occurrence of each path. We then used mediation analysis to assess the proportion of association between parental mental disorders and work disability mediated by offspring's health and social disadvantage.

RESULTS

The pathway model indicated that the association from parental mental disorders to offspring's work disability due to depressive or anxiety disorder is through mental disorders and social disadvantage in adolescence. Odds Ratio for the total effect of parental mental disorders on offspring's psychiatric work disability was 1.85 (95% confidence interval [CI] 1.46-2.34) in the model including offspring's mental disorders that mediated this association by 35%. Corresponding results were 1.86 (95% CI 1.47-2.35) and 28% for social disadvantage in adolescence.

CONCLUSIONS

These findings suggest that intergenerational determination of work disability due to mental disorders could be addressed by actions supporting mental health and social circumstances in adolescence.

Frühkindliche Prädiktoren externalisierender Verhaltensauffälligkeiten

Zusammenfassung. Externalisierende Verhaltensauffälligkeiten sind mit hohen gesellschaftlichen Kosten verbunden. Damit wirksame Präventions- und frühe Therapieprogramme entwickelt werden können, ist es notwendig, bereits in den ersten Lebensjahren Risiken für einen externalisierenden Entwicklungsverlauf zu identifizieren. In einer systematischen Literaturrecherche konnten aus 21 Publikationen zu 12 längsschnittlichen Geburtskohorten mit insgesamt 55 077 Kindern frühe Risiken bezogen auf eine elterliche Psychopathologie, einen niedrigen sozio-ökonomischen Status und ungünstige Eltern-Kind-Interaktionen identifiziert werden. Insbesondere eine mütterliche Depression, ein niedriger sozio-ökonomischer Status und ein harsches Erziehungsverhalten in den ersten Lebensjahren waren prädiktiv für externalisierende Verhaltensauffälligkeiten im Kindergarten und bei Schuleintritt. Implikationen für die klinische Praxis werden vorgestellt.