Stability and change in a predictive model of emotional and behavioural problems from early adolescence to middle adulthood.

The impact of negative life events, self-esteem, and coping behaviour are considered to be contributing factors in the development of emotional and behavioural problems. Differences in the predictive value of these three factors on emotional and behavioural problems from adolescence to adulthood have not yet been studied. Multiple linear regressions separate for the two sexes were used to assess whether the impact of negative life-events, self-esteem, and coping behaviour predicted emotional and behavioural problems at four discrete measurement points from early adolescence to middle adulthood in a cohort of N = 366 participants from a Swiss longitudinal community study. Mostly irrespective of sex, negative life-events and low self-esteem were significant predictors of internalizing problems, externalizing problems and total problem scores in adolescence as well as in adulthood. The explained variance in the model increased steadily from early adolescence to middle adulthood. While the impact of negative life-events was on the same level across all measurements until adulthood, the contribution of self-esteem increased steadily. There was a significant association, particularly in adolescent males, between avoidant coping and emotional and behavioural problems. The cross-sectional findings from this community study reflect long-term robust patterns in the associations of negative life-events, self-esteem, and avoidant coping with emotional and behavioural problems from adolescence to adulthood. Clinically, the three constructs represent actionable targets for optimizing assessment and intervention strategies across the adolescent life-span.

Effects of individual differences, society, and culture on youth-rated problems and strengths in 38 societies.

BACKGROUND: Clinicians increasingly serve youths from societal/cultural backgrounds different from their own. This raises questions about how to interpret what such youths report. Rescorla et al. (2019, European Child & Adolescent Psychiatry, 28, 1107) found that much more variance in 72,493 parents' ratings of their offspring's mental health problems was accounted for by individual differences than by societal or cultural differences. Although parents' reports are essential for clinical assessment of their offspring, they reflect parents' perceptions of the offspring. Consequently, clinical assessment also requires self-reports from the offspring themselves. To test effects of individual differences, society, and culture on youths' self-ratings of their problems and strengths, we analyzed Youth Self-Report (YSR) scores for 39,849 11-17 year olds in 38 societies. METHODS: Indigenous researchers obtained YSR self-ratings from population samples of youths in 38 societies representing 10 culture cluster identified in the Global Leadership and Organizational Behavioral Effectiveness study. Hierarchical linear modeling of scores on 17 problem scales and one strengths scale estimated the percent of variance accounted for by individual differences (including measurement error), society, and culture cluster. ANOVAs tested age and gender effects. RESULTS: Averaged across the 17 problem scales, individual differences accounted for 92.5% of variance, societal differences 6.0%, and cultural differences 1.5%. For strengths, individual differences accounted for 83.4% of variance, societal differences 10.1%, and cultural differences 6.5%. Age and gender had very small effects. CONCLUSIONS: Like parents' ratings, youths' self-ratings of problems were affected much more by individual differences than societal/cultural differences. Most variance in self-rated strengths also reflected individual differences, but societal/cultural effects were larger than for problems, suggesting greater influence of social desirability. The clinical significance of individual differences in youths' self-reports should thus not be minimized by societal/cultural differences, which-while important-can be taken into account with appropriate norms, as can gender and age differences.

Selective attrition does not affect cross-sectional estimates of associations with emotional and behavioral problems in a longitudinal study with onset in adolescence.

The present examination raises the question whether attrition in a longitudinal study leads to biased findings. The Zurich Adolescent Psychology and Psychopathology Study (ZAPPS) originated in 1994 by following a sample of 1239 adolescents with follow-ups after three, six, and 22 years. The study collected data on life-events, self-esteem, and coping behavior as independent and mental problems as dependent variables. The baseline sample was partitioned according to follow-up status for the three subsequent waves of assessment. Baseline measures of associations between independent and dependent variables were compared for those retained in the study (group A) and those lost to follow-up (group B) at each phase of cross-sectional data collection by use of multiple linear regression analyses. There were significant differences for some baseline independent variables between the two groups with small effect sizes. Males and migrants dropped out more frequently. The main findings indicated that the strength of the associations between independent and dependent variables at baseline in the total sample and in each of the two groups as defined by sample sizes at the three follow-ups was close to equal. Thus, one may conclude from the current study that attrition in longitudinal studies rarely affects cross-sectional estimates of associations.

Testing Syndromes of Psychopathology in Parent and Youth Ratings Across Societies.

As societies become increasingly diverse, mental health professionals need instruments for assessing emotional, behavioral, and social problems in terms of constructs that are supported within and across societies. Building on decades of research findings, multisample alignment confirmatory factor analyses tested an empirically based 8-syndrome model on parent ratings across 30 societies and youth self-ratings across 19 societies. The Child Behavior Checklist for Ages 6-18 and Youth Self-Report for Ages 11-18 were used to measure syndromes descriptively designated as Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Social Problems, Thought Problems, Attention Problems, Rule-Breaking Behavior, and Aggressive Behavior. For both parent ratings (N = 61,703) and self-ratings (N = 29,486), results supported aggregation of problem items into 8 first-order syndromes for all societies (configural invariance), plus the invariance of item loadings (metric invariance) across the majority of societies. Supported across many societies in both parent and self-ratings, the 8 syndromes offer a parsimonious phenotypic taxonomy with clearly operationalized assessment criteria. Mental health professionals in many societies can use the 8 syndromes to assess children and youths for clinical, training, and scientific purposes.

A Cross-Lag Panel Analysis of Low Self-Esteem as a Predictor of Adolescent Internalizing Symptoms in a Prospective Longitudinal Study.

Self-esteem, generally regarded as an important indicator of adolescents' mental health, was assessed by a self-report questionnaire in a school sample of 593 subjects who had been assessed at 3 time points over 7 years between 11 and 25 years of age within the Zurich Psychology and Psychopathology Study (ZAPPS). Cross-lagged panel analyses of the longitudinal data from ZAPPS indicated that self-esteem was predictive of internalizing problems and had an impact on internalizing symptoms when the analyses were adjusted for coping behavior, efficiency of social networks, and impact of stressful life events. Self-esteem was also stable (r = .37-.60) within the observed age range, after controlling for prior levels of the predicted variables. The findings support the impact of self-esteem on mental health and indicate the importance of addressing self-esteem in prevention and intervention programs.

Problem coping skills, psychosocial adversities and mental health problems in children and adolescents as predictors of criminal outcomes in young adulthood.

The purpose of this study was to test child and adolescent psychosocial and psychopathological risk factors as predictors of adult criminal outcomes in a Swiss community sample. In particular, the role of active and avoidant problem coping in youths was analysed. Prevalence rates of young adult crime convictions based on register data were calculated. Univariate and multivariate logistic regressions were used to analyse the prediction of adult criminal convictions 15 years after assessment in a large Swiss community sample of children and adolescents (n = 1,086). Risk factors assessed in childhood and adolescence included socio-economic status (SES), migration background, perceived parental behaviour, familial and other social stressors, coping styles, externalizing and internalizing problems and drug abuse including problematic alcohol consumption. The rate of any young adult conviction was 10.1 %. Besides externalizing problems and problematic alcohol consumption, the presence of any criminal conviction in young adulthood was predicted by low SES and avoidant coping even after controlling for the effects of externalizing problems and problematic alcohol use. The other predictors were significant only when externalizing behaviours and problematic alcohol use were not controlled. In addition to child and adolescent externalizing behaviour problems and substance use, low SES and inadequate problem-solving skills, in terms of avoidant coping, are major risk factors of young adult criminal outcomes and need to be considered in forensic research and criminal prevention programs.

Internalizing and externalizing problems, depression, and self-esteem in non-detained male juvenile offenders.

BACKGROUND: High rates of mental disorders have been found in detained juvenile offenders, whereas the role of psychopathology in non-detained offenders is less clear. Therefore, the present study compared psychopathology in male non-detained delinquent juveniles and two matched samples from the community and an adolescent psychiatric clinic. METHODS: 125 male adolescents aged 11 to 19 years (m = 16.2 years, SD = 1.5 years) from an outpatient adolescent forensic clinic were compared to a community sample from the Zurich Adolescent Psychology and Psychopathology Study (ZAPPS) and a referred sample from a psychiatric clinic matched for age and nationality. All subjects responded to questionnaires measuring internalizing and externalizing problems, depressive symptoms and self-esteem. RESULTS: The sample of non-detained juvenile offenders showed similar rates of self-reported internalizing and externalizing problems when compared to the community sample, whereas the clinic sample displayed an increased rate of various disturbances. Similar results were found also for self-esteem. In agreement with these findings, non-detained juvenile offenders less frequently had a psychiatric diagnosis after full clinical assessment when compared to the clinical sample. However, a diagnosis of conduct disorders and a lower IQ range was found more frequently in non-detained juvenile offenders. Offenders with serious delinquent acts and involving weapons showed higher depression scores than the rest of the offenders. CONCLUSION: In non-detained assessment situations before court examination, juvenile offenders present rather normal behaviour. Their lack of awareness of potential behavioural problems should be considered during assessment and treatment of this group of offenders.

Parent- and self-reported dimensions of oppositionality in youth: construct validity, concurrent validity, and the prediction of criminal outcomes in adulthood.

BACKGROUND: Different dimensions of oppositional defiant disorder (ODD) have been found as valid predictors of further mental health problems and antisocial behaviors in youth. The present study aimed at testing the construct, concurrent, and predictive validity of ODD dimensions derived from parent- and self-report measures. METHOD: Confirmatory factor analyses were performed to test a three-dimensional model (ODD-irritability, ODD-headstrong, and ODD-hurtful) and a two-dimensional model (ODD-irritability, ODD-headstrong/hurtful) based on items of the Child Behavior Checklist (CBCL) and the Youth Self Report (YSR) collected in a Swiss community study of 1,031 adolescents (519 boys, 512 girls) aged between 10.7 and 17.9 (M = 13.85, SD = 1.63) years. Logistic regression analyses were applied to predict scores in the clinical range of concurrent CBCL/YSR-anxiety/depression, CBCL/YSR-attention problems, and CBCL/YSR-delinquent behavior and depression as measured by the Center for Epidemiological Studies Depression Scale (CES-D) as well as to predict the presence of adult criminal convictions. RESULTS: CFA findings were in favor of a three-dimensional model rather than a two-dimensional model of ODD. The CBCL/YSR-ODD-irritability scale was related to concurrent self-reported depression, but also to attention problems and delinquent behavior. CBCL/YSR-ODD-hurtful and less strongly also the combined YSR-headstrong/hurtful scale predicted adult criminal outcomes. CONCLUSIONS: As proposed by the DSM-5 workgroup, different ODD-dimensions were confirmed by the present study. ODD-irritability predicts psychiatric comorbidity and ODD-hurtful symptoms should be specifically considered in youth at risk for criminal outcomes.

Cross-informant agreement between parent-reported and adolescent self-reported problems in 25 societies.

We used population sample data from 25 societies to answer the following questions: (a) How consistently across societies do adolescents report more problems than their parents report about them? (b) Do levels of parent-adolescent agreement vary among societies for different kinds of problems? (c) How well do parents and adolescents in different societies agree on problem item ratings? (d) How much do parent-adolescent dyads within each society vary in agreement on item ratings? (e) How well do parent-adolescent dyads within each society agree on the adolescent's deviance status? We used five methods to test cross-informant agreement for ratings obtained from 27,861 adolescents ages 11 to 18 and their parents. Youth Self-Report (YSR) mean scores were significantly higher than Child Behavior Checklist (CBCL) mean scores for all problem scales in almost all societies, but the magnitude of the YSR-CBCL discrepancy varied across societies. Cross-informant correlations for problem scale scores varied more across societies than across types of problems. Across societies, parents and adolescents tended to rate the same items as low, medium, or high, but within-dyad parent-adolescent item agreement varied widely in every society. In all societies, both parental noncorroboration of self-reported deviance and adolescent noncorroboration of parent-reported deviance were common. Results indicated many multicultural consistencies but also some important differences in parent-adolescent cross-informant agreement. Our findings provide valuable normative baselines against which to compare multicultural findings for clinical samples.

The use of the development and well-being assessment (DAWBA) in clinical practice: a randomized trial.

The development and well-being assessment (DAWBA) has been used in various epidemiological studies, whereas the clinical value of the instrument needs support from further studies. In particular, it is important to document how the use of the DAWBA influences clinical decision-making. The present study employed the DAWBA in a consecutive series of 270 new referrals to a large public child and adolescent psychiatric service in Zurich, Switzerland. ICD-10 based diagnoses were obtained from clinicians for all patients and reliability of DAWBA expert raters was calculated. The DAWBA diagnoses were randomly disclosed (n = 144) or not disclosed (n = 126) before clinical decision-making. The reliability of DAWBA expert diagnoses was very satisfactory and the agreement under the disclosed versus the non-disclosed condition amounted to 77 versus 68% for internalizing disorders and to 63 versus 71% for externalizing disorders. The increment in agreement due to disclosure of the DAWBA diagnosis was significant for internalizing disorders. Access to DAWBA information was more likely to prompt clinicians to add an extra diagnosis. Professional background and degree of clinical experience did not affect diagnostic agreement. Overall, diagnostic agreements between DAWBA expert diagnoses and clinical diagnoses were in the fair to moderate range and comparable to previous studies with other structured diagnostic interviews. The inclusion of the DAWBA into the clinical assessment process had an impact on diagnostic decision-making regarding internalizing disorders but not regarding externalizing disorders.

Prediction of major affective disorders in adolescents by self-report measures.

BACKGROUND: The Youth Self-Report (YSR) has been used widely as a screening instrument for adolescent psychopathology. The present study aimed at a test of the diagnostic accuracy of the various YSR-scales including a DSM-oriented affective problem scale (YSR AFF) in the prediction of depressive episodes and a comparison with results based on the Center of Epidemiologic Studies-Depression Scale (CES-D). METHODS: A consecutive clinical sample of 140 adolescents diagnosed with major depressive episodes according to ICD-10 criteria was compared to a sample of 140 non-referred controls matched by age and sex from a community survey. All subjects responded both to the YSR and CES-D. Diagnoses were provided by the treating clinicians. Receiver Operating Characteristics (ROC) analyses were performed and cut-off scores were calculated based on quality efficiency statistics. RESULTS: The YSR AFF scale was found to have high diagnostic accuracy and showed quite comparable results to the CES-D scale. None of the other multivariate model showed a better performance in the identification of major depression disorders. Based on quality efficiency indicator analyses, scores between 5 and 9 on the YSR AFF scale and between 12 and 31 on the CES-D scale served best in the prediction of clinical depressive episodes in adolescents. LIMITATIONS: No formal reliability test of the diagnoses was available. CONCLUSION: The DSM-oriented YSR AFF scale shows a high diagnostic accuracy and can be recommended for the clinical assessment of depression in adolescents.

The relevance of body weight in the medium-term to long-term course of adolescent anorexia nervosa. Findings from a multisite study.

OBJECTIVE: The relevance of repeated body mass index (BMI) assessments for long-term outcome in anorexia nervosa (AN) was studied. METHOD: Two-hundred and twelve adolescent patients aged 10-18 (Mean 14.9) years from five sites were followed up for an average of 8.3 years after first admission. Various predictors of BMI at follow-up were analyzed. RESULTS: In comparison to subjects with normal BMI (>17.5) at final follow-up, subjects with BMI <17.5 had significantly lower age-adjusted BMI prior to onset of the disorder and at discharge from first admission. In addition, all outcome scores indicated poorer functioning in the group with BMI < 17.5. The BMI prior to onset of AN, the BMI at first hospital admission and discharge, and the BMI at final follow up were significantly correlated across time. Higher BMI prior to onset of AN, higher BMI at first discharge, and lower age at first admission predicted a normal BMI (>17.5) at follow-up in a model of logistic regression. CONCLUSION: The long-term outcome of adolescent AN reflects the normal tracking of BMI over time. Presumably, the tracking in AN patients is somewhat reduced in comparison to healthy subjects.

Performance of the adolescent obsessive-compulsive scale in a community survey.

Obsessive-compulsive behavior was studied in a cohort of N=570 subjects who had been assessed at three times between adolescence and young adulthood. Based on the Youth Self-Report (YSR) and the Young Adult Self-Report (YASR), the adolescent obsessive-compulsive scale (AOCS) was defined. At each of the three assessments, subjects scoring above the cut-off score of the 90th percentile of the AOCS were identified and compared to the rest of the sample serving as control group. The risk group was clearly more abnormal in both domains of internalizing and externalizing across time. Various psychiatric disorders in young adulthood were predicted by the AOCS. However, concomitant general psychopathology also contributed strongly to the prediction. Parent and youth agreement on group membership was rather low. Stability of group assignment across time was significantly increased. The AOCS is a promising instrument both for epidemiological and clinical studies. Its content and predictive validity deserves further studies.

Frequency, stability and differentiation of self-reported school fear and truancy in a community sample.

BACKGROUND: Surprisingly little is known about the frequency, stability, and correlates of school fear and truancy based on self-reported data of adolescents. METHODS: Self-reported school fear and truancy were studied in a total of N = 834 subjects of the community-based Zurich Adolescent Psychology and Psychopathology Study (ZAPPS) at two times with an average age of thirteen and sixteen years. Group definitions were based on two behavioural items of the Youth Self-Report (YSR). Comparisons included a control group without indicators of school fear or truancy. The three groups were compared across questionnaires measuring emotional and behavioural problems, life-events, self-related cognitions, perceived parental behaviour, and perceived school environment. RESULTS: The frequency of self-reported school fear decreased over time (6.9 vs. 3.6%) whereas there was an increase in truancy (5.0 vs. 18.4%). Subjects with school fear displayed a pattern of associated internalizing problems and truants were characterized by associated delinquent behaviour. Among other associated psychosocial features, the distress coming from the perceived school environment in students with school fear is most noteworthy. CONCLUSION: These findings from a community study show that school fear and truancy are frequent and display different developmental trajectories. Furthermore, previous results are corroborated which are based on smaller and selected clinical samples indicating that the two groups display distinct types of school-related behaviour.

Frequency, course and correlates of alcohol use from adolescence to young adulthood in a Swiss community survey.

BACKGROUND: Few studies have analyzed the frequency of alcohol use across time from adolescence to young adulthood and its outcome in young adulthood. A Swiss longitudinal multilevel assessment project using various measures of psychopathology and psychosocial variables allowed for the study of the frequency and correlates of alcohol use so that this developmental trajectory may be better understood. METHOD: Alcohol use was studied by a questionnaire in a cohort of N = 593 subjects who had been assessed at three times between adolescence and young adulthood within the Zurich Psychology and Psychopathology Study (ZAPPS). Other assessment included questionnaire data measuring emotional and behavioural problems, life events, coping style, self-related cognitions, perceived parenting style and school environment, and size and efficiency of the social network. RESULTS: The increase of alcohol use from early adolescence to young adulthood showed only a few sex-specific differences in terms of the amount of alcohol consumption and the motives to drink. In late adolescence and young adulthood, males had a higher amount of alcohol consumption and were more frequently looking for drunkenness and feeling high. Males also experienced more negative consequences of alcohol use. A subgroup of heavy or problem drinkers showed a large range of emotional and behavioural problems and further indicators of impaired psychosocial functioning both in late adolescence and young adulthood. CONCLUSION: This Swiss community survey documents that alcohol use is problematic in a sizeable proportion of youth and goes hand in hand with a large number of psychosocial problems.

Continuity, psychosocial correlates, and outcome of problematic substance use from adolescence to young adulthood in a community sample.

BACKGROUND: The study of the continuity, psychosocial correlates, and prediction of problematic substance use (PSU) across time from adolescence to young adulthood. METHODS: Substance use was studied in a cohort of N = 593 subjects who had been assessed at three times between adolescence and young adulthood within the Zurich Psychology and Psychopathology Study (ZAPPS). Based on the frequency of tobacco, alcohol, and cannabis consumption, groups with PSU were defined at each of the three measurement points in time and compared to the rest of the sample. Comparisons included questionnaire data regarding emotional and behavioural problems, life events, coping style, self-related cognitions, perceived parenting style, perceived school environment, and size and efficiency of the social network. RESULTS: The size of the groups with PSU increased continuously across time. The cross-sectional correlates of PSU were characterized by a similar pattern that included higher scores for externalizing behaviour, and both number and negative impact of life events across all three times. At time 1 and 2 subjects with PSU also experienced less favourable parenting styles and school environments. Longitudinally, PSU in young adulthood was predicted most strongly and persistently by previous risk status, externalizing problems and male gender. CONCLUSION: Problematic substance use is a major problem in youth. Its contributing pattern of associated and predictive psychosocial variables can be identified in the community.

Testing the 8-syndrome structure of the child behavior checklist in 30 societies.

There is a growing need for multicultural collaboration in child mental health services, training, and research. To facilitate such collaboration, this study tested the 8-syndrome structure of the Child Behavior Checklist (CBCL) in 30 societies. Parents' CBCL ratings of 58,051 6- to 18-year-olds were subjected to confirmatory factor analyses, which were conducted separately for each society. Societies represented Asia; Africa; Australia; the Caribbean; Eastern, Western, Southern, and Northern Europe; the Middle East; and North America. Fit indices strongly supported the correlated 8-syndrome structure in each of 30 societies. The results support use of the syndromes in diverse societies.

Epidemiological comparisons of problems and positive qualities reported by adolescents in 24 countries.

In this study, the authors compared ratings of behavioral and emotional problems and positive qualities on the Youth Self-Report (T. M. Achenbach & L. A. Rescorla, 2001) by adolescents in general population samples from 24 countries (N = 27,206). For problem scales, country effect sizes (ESs) ranged from 3% to 9%, whereas those for gender and age ranged from less than 1% to 2%. Scores were significantly higher for girls than for boys on Internalizing Problems and significantly higher for boys than for girls on Externalizing Problems. Bicountry correlations for mean problem item scores averaged .69. For Total Problems, 17 of 24 countries scored within one standard deviation of the overall mean of 35.3. In the 19 countries for which parent ratings were also available, the mean of 20.5 for parent ratings was far lower than the self-report mean of 34.0 in the same 19 countries (d = 2.5). Results indicate considerable consistency across 24 countries in adolescents' self-reported problems but less consistency for positive qualities.

Risk factors for the development of emotional and behavioural problems in children born to drug-dependent mothers.

BACKGROUND: The study of biological and psychosocial risk factors for the development of emotional and behavioural problems in children of drug-dependent mothers. METHODS: In a sample of 52 children and drug-dependent mothers participating in a residential intervention programme emotional and behavioural problems were studied in the children by use of the Child Behaviour Checklist (CBCL). The Symptom-Checklist Revised (SCL-90-R) served to assess mental problems in the mother. Drug exposure during pregnancy, various psychosocial risk factors due to the drug-career, and educational status of the mother were assessed by maternal interview. A brief assessment of intelligence of the mother was included. RESULTS: Among the various biological and psychosocial risk factors, maternal mental health problems, maternal educational status, and a small number of close social relationships correlated significantly with child outcome variables. Multiple regression analyses identified maternal mental health factors as the main predictors of child behaviour. CONCLUSIONS: Assisting drug-dependent mothers in overcoming the psychosocial sequelae of drug abuse implies also assistance to the children in terms of prevention of emotional and behavioural problems.

Stability, correlates, and outcome of adolescent suicidal risk.

BACKGROUND: The goal of this study was to investigate the stability and correlates of adolescent suicidal risk across adolescence. METHODS: Suicidal risk was studied longitudinally in N = 593 subjects in 1994, 1997, and 2001 at mean ages of 13, 16, and 20 years. Three partly overlapping suicidal risk groups were compared to three control groups matched by age and gender regarding behavioural and emotional problems, number and impact of life events, coping capacities, self-related cognitions, and the size and efficiency of the social network. Psychiatric diagnoses were obtained in young adulthood. RESULTS: The group stability of suicidal risk was 43% from time 1 to time 2 and 18% from time 1 to time 3. Intra-individual stability of suicidal risks across adolescence was significantly higher than expected. At all three times of assessment, there was a clear excess of abnormal psychosocial findings in the suicidal risk groups as compared to the matched controls. Substance abuse disorders, depressive disorders, phobias and any psychiatric disorders in young adulthood were predicted by suicidal risk in preadolescence irrespective of behavioural and emotional disorders. CONCLUSIONS: Suicidal risk individuals are remarkably stable across adolescence and show a very consistent pattern of associated behavioural and emotional problems and psychosocial variables across time from preadolescence to young adulthood. They also display an increased risk for some mental disorders in young adulthood.