Testing sex-specific pathways from peer victimization to anxiety and depression in early adolescents through a randomized intervention trial.

The aim of this study was to test for sex differences in the role of physical and relational victimization in anxiety and depression development through a randomized prevention trial. 448 seven-year-old boys and girls were randomly assigned to the Good Behavior Game intervention, a two-year universal classroom based intervention aimed at reducing disruptive behavior problems and creating a safe and predictable classroom environment, or to a control condition. Assessments of self-reported physical and relational victimization at age 10 years, and self-reported major depressive disorder, generalized anxiety, social anxiety, and panic/agoraphobia symptoms at age 13 years were available. Reductions in anxiety/depression were mediated by reduced rates of relational victimization in girls, whereas reductions in physical victimization accounted for the reduced anxiety/depression scores among boys. The results support sex-specific pathways of victimization leading to anxiety and depression.

Ethnic disparities in mental health and educational attainment: comparing migrant and native children.

UNLABELLED: STUDY BACKGROUND AND AIMS: Ethnic disparities in mental health in adolescence may play a role in the development of ethnic disparities in educational attainment. The aim of this study was to assess the contribution of ethnic disparities in mental health problems in adolescence to ethnic disparities in educational attainment in adulthood. METHODS: We followed two community samples of respectively 486 Dutch native and 168 Turkish migrant adolescents (11-15 years old) into adulthood (21-25 years old). Mental health was measured in adolescence, and educational attainment was assessed in adulthood. The contribution of mental health disparities to educational disparities was estimated by the degree of attenuation of the odds ratio (OR) for low education after adjustment for mental health problems. RESULTS: Adult Turkish men more often had attained lower education than Dutch men (OR 1.81 (1.01-3.25)). Additional adjustment for mental health problems during adolescence did not change the OR. In Turkish women, however, the OR was 1.94 (1.04-3.62), and adjustment for mental health problems lowered it by 96% to 1.04 (0.51-2.14). The contribution was mostly due to ethnic disparities in internalizing problems. CONCLUSION: In women, but not in men, ethnic disparities in mental health, especially internalizing problems, were a strong predictor for the development of ethnic disparities in educational attainment. Prevention or treatment of internalizing problems among Turkish girls will probably contribute to the prevention of educational disparities.

Determinants of daily smoking in Turkish young adults in the Netherlands.

BACKGROUND: As little is known about the determinants of smoking in large ethnic minorities in the Netherlands and other Western European countries, we studied the determinants of smoking young adult offspring of Turkish migrants to the Netherlands. METHODS: Cross-sectional survey of 439 Turkish adults (18-28 y) in 2003. Smokers were compared with never smokers for five groups of determinants: demographic and socioeconomic factors, behavioral and emotional problems, psychosocial factors, and cultural factors. Associations were measured by prevalence rate ratios. RESULTS: Prevalences for men were 51% for daily smoking, 12% for former smoking, and 38% for never smoking. For women they were 44%, 11%, and 47%, respectively. Without adjustment for other determinants, higher prevalence was associated with: emotional problems, boredom, life events, and being male; and, specifically among women, with low self-esteem and having children. The strongest determinants of daily smoking In multivariate models were alcohol use and demographic and socio-economic factors. Of the cultural factors only strong Muslim identification was associated with lower smoking prevalence. CONCLUSION: The high prevalence of smoking warrants action. Many of the well-known determinants of smoking in Western countries were also important among young adults from ethnic minorities. Women with children and people of a low educational level deserve special attention.

Trajectories of peer-nominated aggression: risk status, predictors and outcomes.

Developmental trajectories of peer-nominated aggression, risk factors at baseline, and outcomes were studied. Peer nominations of aggression were obtained annually from grades 1 to 3. Three developmental trajectories were identified: an early-onset/increasers trajectory with high levels of peer-nominated aggression at elementary school entry and increasing levels throughout follow-up; a moderate-persistent trajectory of aggression in which children were characterized by moderate levels of physical aggression at baseline; and a third trajectory with stable low levels of aggression. Children following the early-onset/increasers trajectory showed physical forms of aggression at baseline. Male gender and comorbid attention deficit/hyperactivity problems, oppositional defiant problems and poor prosocial behavior plus negative life events predicted which children would follow the early-onset/increasers trajectory of aggression. The outcomes associated with the early-onset/increaser children suggest high risk for chronically high levels of aggressive behavior.

Understanding mechanisms of change in the development of antisocial behavior: the impact of a universal intervention.

The association between the development of antisocial behavior, affiliation with deviant friends, and peer rejection was tested with a preventive intervention; 664 boys and girls were randomly assigned to a universal classroom-based intervention targeting disruptive behavior or a control condition. Peer nominations of antisocial behavior, friends' antisocial behavior, and peer rejection were assessed annually for 4 years. A high, a moderate, and a stable low antisocial behavior trajectory were identified. Large reductions in antisocial behavior were found among intervention children who followed the high trajectory. These reductions coincided with affiliations with nondeviant peers and with decreases in peer rejection. The affiliation between deviant and nondeviant peers was initiated by nondeviant children. The results support a causal role of deviant friends and peer rejection in the development of antisocial behavior. The implications for our understanding of the mechanisms leading to reductions in antisocial behavior are discussed.

Screening for disruptive behavior syndromes in children: the application of latent class analyses and implications for prevention programs.

The predictive accuracy of classifying children at risk for disruptive disorders through latent class analyses (LCA) was evaluated. Child Behavior Checklist/4-18 (T. M. Achenbach, 1991) items, reflecting symptoms of Diagnostic and Statistical Manual of Mental Disorders (4th ed., American Psychiatric Association, 1994) defined disruptive disorders, alone and in combination with other child and familial risk factors, were used to predict children's risk for disruptive disorder. Predictive accuracy reached a positive predictive value of 69%. Children incorrectly classified (false positive and false negative) were compared with correctly classified children (true positive and true negative) on risk factors in the family context to test whether the screening procedure could be improved through a multiple-gating procedure. The differences in familial context factors between these children were limited, and no clear indications were found on how to use familial context factors to improve the screening procedure after the initial classification by LCA.

Preventing disruptive behavior in elementary schoolchildren: impact of a universal classroom-based intervention.

A population-based, randomized universal classroom intervention trial for the prevention of disruptive behavior (i.e., attention-deficit/hyperactivity problems, oppositional defiant problems, and conduct problems) is described. Impact on developmental trajectories in young elementary schoolchildren was studied. Three trajectories were identified in children with high, intermediate, or low levels of problems on all 3 disruptive behaviors at baseline. The intervention had a positive impact on the development of all disruptive behavior problems in children with intermediate levels of these problems at baseline. Effect sizes of mean difference at outcome were medium or small. In children with the highest levels of disruptive behavior at baseline, a positive impact of the intervention was found for conduct problems.

Effect of nurse home visits vs. usual care on reducing intimate partner violence in young high-risk pregnant women: a randomized controlled trial.

BACKGROUND: Expectant mothers and mothers of young children are especially vulnerable to intimate partner violence (IPV). The nurse-family partnership (NFP) is a home visitation program in the United States effective for the prevention of adverse child health outcomes. Evidence regarding the effect of nurse home visiting on IPV is inconsistent. This study aims to study the effect of VoorZorg, the Dutch NFP, on IPV. METHODS: A random sample of 460 eligible disadvantaged women <26 years, with no previous live births, was randomized. Women in the control group (C; n=223) received usual care; women in the intervention group (I; n=237) received usual care plus nurse home visits periodically during pregnancy and until the child's second birthday. RESULTS: At 32 weeks of pregnancy, women in the intervention group self-reported significantly less IPV victimization than women in the control group in: level 2 psychological aggression (C: 56% vs. I: 39%), physical assault level 1 (C: 58% vs. I: 40%) and level 2 (C: 31% vs. I: 20%), and level 1 sexual coercion (C: 16% vs. I: 8%). Furthermore, women in the intervention group reported significantly less IPV perpetration in: level 2 psychological aggression (C: 60% vs. I: 46%), level 1 physical assault (C: 65% vs. I: 52%), and level 1 injury (C: 27% vs. I: 17%). At 24 months after birth, IPV victimization was significantly lower in the intervention group for level 1 physical assault (C: 44% vs. I: 26%), and IPV perpetration was significantly lower for level 1 sexual assault (C: 18% vs. I: 3%). Multilevel analyses showed a significant improvement in IPV victimization and perpetration among women in the intervention group at 24 months after birth. CONCLUSION: VoorZorg, compared with the usual care, is effective in reducing IPV during pregnancy and in the two years after birth among young high-risk women. TRIAL REGISTRATION: Dutch Trial Register NTR854 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=854.

Paternal depressive symptoms during pregnancy are related to excessive infant crying.

OBJECTIVE: Excessive infant crying, or infantile colic, is a common and often stress-inducing problem for parents that can ultimately result in child abuse. From previous research it is known that maternal depression is related to excessive crying, but so far little is known about the influence of paternal depression. METHODS: In a prospective, population-based study, we obtained information on both maternal and paternal depressive symptoms at 20 weeks of pregnancy by using the Brief Symptom Inventory. Parental depressive symptoms were related to excessive crying in 4426 two-month-old infants. The definition of excessive crying was based on the widely used Wessel's criteria (ie, crying >3 hours for >3 days in the past week). RESULTS: After adjustment for depressive symptoms of the mother and relevant confounders, we found a 1.29 (95% confidence interval: 1.09-1.52) higher risk of excessive infant crying per SD of paternal depressive symptoms. CONCLUSIONS: Our findings indicate that paternal depressive symptoms during pregnancy might be a risk factor for excessive infant crying. This finding could be related to genetic transmission, interaction of a father with lasting depressive symptoms with the infant, or related indirectly through contextual stressors such as marital, familial, or economic distress.

Development of ethnic disparities in internalizing and externalizing problems from adolescence into young adulthood.

BACKGROUND: Little is known about changes in ethnic disparities in mental health during the development of adolescents into young adults. The aim of this study was to study the development of disparities in internalizing and externalizing problems between Dutch natives and Turkish migrant children from adolescence into adulthood. METHODS: Turkish migrants (n = 217) and Dutch natives (n = 723) completed two comparable questionnaires about internalizing and externalizing problems: the Youth Self-Report at age 11-18 and the (Young) Adult Self-Report ten years later, at age 21-28. We used mixed linear regression models to model development of mental health problems and to test changes in disparities in mental health between Turkish migrants and Dutch natives. RESULTS: Both in adolescence and in adulthood migrants reported more internalizing and externalizing problems than natives, most pronounced for internalizing problems. Disparities decreased from adolescence into adulthood for both internalizing problems (-52%, p < .0001) and externalizing problems (-67%, p = .01), independently of gender, age, country of birth of Turkish adolescents, and parental socio-economic position. The favorable changes in the disparities over time were due to more favorable development among Turkish migrants than among natives. CONCLUSIONS: In this prospective study, ethnic disparities in internalizing and externalizing problems decreased as adolescents entered adulthood. Different explanations are discussed.

Ethnic disparities in problem behaviour in adolescence contribute to ethnic disparities in social class in adulthood.

BACKGROUND: It is important for prevention of social class disparities to know how ethnic disparities in social class arise among migrant children. We contribute to this understanding by examining the role of problem behaviour in adolescence. METHODS: Prospective observational study with 753 Dutch native and 217 Turkish migrant adolescents (11-18 year) followed for 10 years. Internalising and externalising problems were assessed in adolescence and employment status and occupational level were assessed in adulthood. The difference in odds ratios (OR) before and after adjustment for internalising and externalising problems was an indication of the predictive value of disparities in internalising and externalising problems for the development of social class disparities. RESULTS: A total of 135 (62%) of the Turkish and 602 (80%) of the Dutch adults were employed. Internalising and externalising problems were not associated with employment status. Of the employed, 65 (48%) Turkish and 179 (30%) Dutch adults worked in low-level occupations (p < 0.0001). Internalising and externalising problems were associated with both ethnicity and occupation. The OR for low-level occupation for Turkish adults was 1.78 (1.19-2.65), indicating ethnic disparities. Adjustment for internalising problems lowered the OR with 36% to 1.50 (0.97-2.31), and adjustment for externalising problems lowered it with 8% to 1.72 (1.15-2.57). Findings were similar for men and women and did not vary by age. CONCLUSIONS: Ethnic disparities in occupational level in adulthood could partly be attributed to disparities in mental health between Turkish migrants and Dutch natives in adolescence. Prevention of ethnic disparities in mental health at young age may therefore also contribute to the prevention of occupational differences in adulthood.

Prenatal smoking predicts non-responsiveness to an intervention targeting attention-deficit/hyperactivity symptoms in elementary schoolchildren.

BACKGROUND: Some evidence suggests that prenatal exposure to maternal smoking contributes to the etiology of Attention-Deficit/Hyperactivity Disorder (ADHD). The present study tested an intervention targeting disruptive behavior to establish whether exposure to maternal smoking during pregnancy predicts intervention failure in elementary schoolchildren. METHODS: Five hundred and eight elementary schoolchildren were followed from ages 7 to 11. At ages 8 and 9, they were randomly assigned to a control condition, or to a two-year universal classroom-based intervention targeting disruptive behavior. Measures included maternal reports of smoking during pregnancy, teacher-rated symptoms of ADHD from ages 7 to 9 years, and children's self-report of experimentation with smoking at ages 10 and 11 years. RESULTS: At age 7, prenatally exposed children had higher ADHD symptom scores. The intervention did not affect the course of their ADHD symptoms and the probability of early-onset experimentation with smoking. Among non-exposed children, the intervention positively affected the course of ADHD symptoms, and reduced the probability of early-onset experimentation with smoking. CONCLUSIONS: Prenatally exposed children are most prone to follow a path of high levels of ADHD symptoms and associated elevated risk for early-onset experimentation with smoking, which is unreceptive to a universal preventive intervention. In these children, the developmental course of ADHD symptoms seems to have been influenced by their prenatal exposure to maternal smoking. Future research should further explore whether prenatal smoking is a proxy measure that indexes another risk factor, or a causal factor for adverse developmental outcomes.

Internalising and externalising behaviours in young adults: Dutch natives and Turkish migrants in the Netherlands.

OBJECTIVE: To compare the prevalence of internalising and externalising behaviour of Dutch and Turkish migrant young adults in the Netherlands. We will also assess associations with socio-economic position. METHOD: Dutch natives (1,236) and Turkish migrants (438), age 18-28, completed the Young Adult Self-Report. Scores above the 90th percentile of the distribution of the Dutch sample were defined as deviant. RESULTS: Turkish migrants more often reported deviant scores than natives for internalising problems, especially for the Anxious/Depressed syndrome. For externalising problems, Turkish migrants less often had deviant scores for Intrusive Behaviour, whereas Turkish women more often had deviant scores for Aggressive and Delinquent Behaviour. Similar results were found for comparison between mean scores. After adjustment for socio-economic position, the disparities in men remained, whereas disparities in women largely disappeared. CONCLUSION: Compared with Dutch young adults, Turkish migrant young adults reported more problems. Ethnic disparities were strongly associated with socio-economic disparities among women, but not among men.

Gender differences in developmental links among antisocial behavior, friends' antisocial behavior, and peer rejection in childhood: results from two cultures.

This study addressed gender differences in the developmental links among antisocial behavior, friends' antisocial behavior, and peer rejection. High and increasing, moderate, and low antisocial developmental trajectories were identified among 289 Dutch children, ages 7 to 10, and 445 French-Canadian children, ages 9 to 12. Only boys followed the high trajectory. These boys had more deviant friends and were more often rejected than other children. A minority of girls followed the moderate antisocial behavior trajectory. These girls had fewer deviant friends than moderate antisocial boys, but moderate antisocial boys and girls were equally likely to be rejected. The influence of friends and poor peer relations plays a crucial but different role in the development of antisocial behavior among boys and girls.

Predicting internalizing problems in Moroccan immigrant adolescents in The Netherlands.

BACKGROUND: With the increasing number of immigrants worldwide, it is essential to have insight into the factors associated with internalizing problems in immigrant youth. However, little research on this subject has been conducted. The aim of the current study is to contribute to the knowledge in this field. METHODS: Data were obtained from the general population of 11- to 18-year-old Moroccan immigrant adolescents in The Netherlands. Using the Child Behavior Checklist (CBCL), Youth Self-Report (YSR), and Teacher's Report Form (TRF), 415 parent, 376 self-, and 238 teacher reports were available for analysis. RESULTS: The data showed relations between internalizing problems and several child (externalizing and chronic health problems), proximal family (paternal and maternal support and parent-child conflict), contextual family (conflicts between parents about parenting and total number of life-events), school/peer (being bored), and migration variables (adolescent's perceived discrimination). Moreover, a modest relation was found between internalizing problems and parental psychopathology. Few associations occurred with the global family factor (e.g., family educational level). Several relations between the predictors and YSR internalizing proved to be gender-specific. CONCLUSIONS: Our results suggested that the child, school/peer, and proximal family factors are the most important in predicting the development of internalizing problems in Moroccan immigrant adolescents. The impact of the migration factor was small.

Predicting externalizing problems in Moroccan immigrant adolescents in the Netherlands.

BACKGROUND: Although an increasing proportion of the population in Western countries originates from non-Western parts of the world, little research has been conducted on predictors of externalizing problems in immigrant adolescent samples. This study on the predictors of externalizing problems in Moroccan immigrant adolescents in the Netherlands was aimed to contribute to the knowledge in this field. METHODS: We obtained 415 parent-reports, 376 self-reports and 238 teacher-reports on problem behavior in a general population sample of randomly selected 11- to 18-year-old Moroccan immigrant adolescents, using the Child Behavior Checklist, Youth Self-Report and Teacher's Report Form. RESULTS: The data revealed a clear relation between externalizing problems and several child (gender, internalizing problems), proximal family (parental monitoring and affection, support from father and mother, and parent-child conflict), contextual family (conflicts between parents about parenting, destructive communication between parents, and total number of life-events), school/peer (problems at school, involvement with deviant peers, hanging out), and migration variables (adolescent's perceived discrimination). Hardly any association was observed between externalizing problems and parental psychopathology, and between externalizing problems and global family variables (e.g., family employment level). Most findings matched results found in earlier studies on non-immigrant youth. CONCLUSIONS: Our results suggest that the child, school/peer, and proximal family factors are essential in models predicting the development of externalizing behavior. The impact of the migration factor on externalizing problems turned out to be relatively small.

Prevalence and determinants of minor psychiatric disorder in Turkish immigrants living in The Netherlands.

BACKGROUND: The aim of this study was to assess the prevalence of and risk and protective factors for minor psychiatric disorder in a general population sample of Turkish immigrants living in the Netherlands. METHODS: Minor psychiatric disorder was assessed with the 28-item version of the General Health Questionnaire. Demographic, immigration, social and support, and stress related variables were assessed with the Turkish Immigrant Assessment Questionnaire. The study sample was a randomly selected sample of 262 male and 523 female Turkish immigrants. RESULTS: Of all immigrants, 33.4% experience minor psychiatric disorder with more females (36.1%) than males (27.9%) with disorder. For males, unemployment is a strong risk factor, whereas for females the burden of additional tasks (physical illness and inclusion of family members) in the household increases the risk for psychiatric disorder. For both males and females, however, the quality of the relationship with their partner in addition to enduring stresses around housing and finances are associated with elevated risks. CONCLUSIONS: The incidence of minor psychiatric disorder in this sample of Turkish immigrants living in the Netherlands is higher than the incidence normally found in general population samples. The expression of somatic complaints around 'tightness' should alert physicians to further explore symptoms of minor psychiatric disorder and to examine sources of distress stemming from the partner relationship, the family, work and from poor housing and financial conditions.

Classes of disruptive behaviour in a sample of young elementary school children.

BACKGROUND: The objectives were to (1) classify young children to groups differing in disruptive behaviour, (2) determine whether the patterns of disruptive behaviour in these groups are in accordance with the conceptualisation of disruptive disorders as described in DSM-IV, and (3) optimise the classification of children in groups. METHODS: Disruptive behaviour of 636 seven-year-old elementary schoolchildren was assessed with the CBCL/4-18. Using CBCL items rated as very consistent with DSM-IV categories Conduct Disorder, Oppositional Defiant Disorder and Attention-Deficit/Hyperactivity Disorder, latent class analyses were applied to identify classes of children differing in patterns of disruptive behaviour. RESULTS: Three classes were identified: (1) high levels of oppositional defiant problems (ODD problems) and attention-deficit/hyperactivity problems (ADH problems) and intermediate levels of Conduct problems; (2) intermediate ODD problems and ADH problems and low levels of Conduct problems; (3) low levels on all disruptive behaviours. CONCLUSIONS: No classes were identified in which children had symptoms of only Conduct problems, only ODD problems or only ADH problems. Covariates (socio-economic status, gender, parenting stress) improved the classification of children. The findings are discussed in terms of implications for classification, identification of children at risk, prevention and treatment of disruptive behaviour in young children.

Predictors of self-reported problem behaviours in Turkish immigrant and Dutch adolescents in the Netherlands.

BACKGROUND: Although many studies have compared psychopathology in different cultures, not much is known about factors that contribute to the observed differences. METHODS: We compared self-reported emotional and behavioural problems in 363 Turkish immigrant and 1098 Dutch adolescents in the Netherlands and we evaluated the contribution of adolescent, parent, family and stress-related factors to the observed ethnic differences. Data were drawn from the Dutch version of the Youth Self-Report (YSR), as well as from Dutch and Turkish parental questionnaires. RESULTS: Turkish girls scored higher on four of the eight YSR syndrome-scales, on the Internalising broadband scale and on total problems than Dutch girls. Turkish boys scored higher on three syndrome scales and on the Internalising scale, but scored less on Delinquent Behaviour than their Dutch peers. Ethnic differences for both sexes were most pronounced on the Withdrawn and Anxious/Depressed scales. Socio-economic measures, in particular education of the parents, contributed most to the explanation of ethnic differences on the Somatic Complaints scale for girls and Social Problem and Internalising scales for boys. On most scales, however, ethnic differences could not be explained by other factors. The distribution of some factors appeared to be more favourable (i.e., less frequent) for Turkish than for Dutch youths, such as referral of family members to mental health services. CONCLUSIONS: Low educational levels of the parents play an important, yet not an exclusive role in explaining cross-cultural differences in emotional and behavioural problems in adolescents. In particular, differences in Withdrawn and Anxious/Depressed behaviour could not be explained by non-cultural factors. This study offers starting-points for future research on cultural-specific predictors of psychopathology in immigrants.

Comparison of self-reported emotional and behavioral problems in Turkish immigrant, Dutch and Turkish adolescents.

OBJECTIVE: The aim of this study was to compare self-reported emotional and behavioral problems for Turkish immigrant, native Dutch and native Turkish adolescents. METHOD: A total of 379 Turkish immigrant adolescents living in the Netherlands, and 1039 Dutch adolescents from the general population completed the Dutch translation of the Youth Self-Report (YSR); 2151 Turkish adolescents from the general population completed the Turkish translation of the YSR; parents of Turkish immigrant adolescents filled in the Turkish translation of the Child Behavior Checklist (CBCL/4-18). RESULTS: Turkish immigrant adolescents scored themselves significantly higher than Dutch adolescents on five of the 11 YSR syndromes, most markedly on the Anxious/Depressed, Withdrawn and Internalizing scales. Dutch adolescents scored themselves higher than immigrant adolescents on the Somatic Complaints and Delinquent Behavior scales. Turkish immigrant adolescents scored themselves higher than Turkish adolescents on five of the 11 scales, most markedly on the Delinquent Behavior scale. Total problems scores for Turkish immigrant adolescents were higher than for Dutch and Turkish adolescents. Turkish immigrant adolescents scored themselves higher than their parents assessed them on seven of the 11 scales. CONCLUSION: Turkish immigrant adolescents reported more problems in comparison to their Dutch and native Turkish peers. Different patterns of parent-child interaction, family values and delay of Dutch language skills are considered to be responsible for these differences in scores.