Exploring longitudinal associations between internalizing and externalizing problems in immigrant boys and girls: comparing native Dutch and Moroccan immigrant adolescents

Background: This longitudinal study compares the relationship between internalizing and externalizing problems in Moroccan immigrant and native Dutch adolescents over a period of four years. Method: By using generalized estimating equations (GEE) the strength and stability of associations between internalizing and externalizing problems in 159 Moroccan and 159 Dutch adolescents was studied. Results: No differences in strength of co-occurring problems were found between Moroccan and Dutch boys. Moroccan girls showed stronger associations between depression and externalizing behavior than Dutch girls. Furthermore, for Moroccan adolescents associations between problems increased over time, whereas in Dutch adolescents associations remained stable. Conclusions: These results may indicate a high risk for multiple mental health problems in Moroccan girls. Moreover, the increase of co-occurring problems may be a result of undertreatment and increasing complexity of problems in Moroccans during adolescence. Investigating processes leading to co-occurring problems in immigrant youths is needed to optimize prevention and intervention efforts in this high-risk group. Proefschrift 10juli_final.indd 74 10-07-2013 22:43:02 | 75 Internalising and externalising problems in immigrant adolescents INTRODUCTION In both epidemiological and clinical samples, externalizing problems often co-occur with internalizing problems (Angold & Costello, 1993; Capaldi & Stoolmiller, 1999; Fergusson & Woodward, 2002; Vermeiren et al., 2002a; Beyers & Loeber, 2003; Ritakallio et al., 2008). Adolescents with co-occurring externalizing and internalizing problems comprise a highly vulnerable group, being at extreme risk of demonstrating problems in various life domains, including school failure, violent behavior, and adult psychiatric illness (Capaldi, 1992; Capaldi & Stoolmiller, 1999; McCarty et al., 2006). In addition, co-occurring problems may be related to poorer treatment success (Newman, Moffitt, Caspi & Silva, 1998; Ollendick, Jarrett, Grills-Taquechel, Hovey & Wolff, 2008). Based on theoretical frameworks, internalizing and externalizing problems are likely to cooccur (for a review see Bubier & Drabick, 2009). First, it is suggested that externalizing and internalizing problems are caused by shared risk factors, and as a result individuals faced with these risk factors may develop both problems simultaneously (e.g., Oland & Shaw, 2005; Chen & Simons-Morton, 2009). Second, the acting out model, proposes that some depressed or anxious adolescents act out their internalizing problems in externalizing behavior (Capaldi, 1992; Ritakallio et al., 2008). As a result, internalizing problems are masked by anti-social behavior. Last, the failure model proposes that due to continuous negative feedback on their externalizing behavior, those adolescents are also vulnerable for internalizing problems (Capaldi, 1992; Beyers & Loeber, 2003; Masten et al., 2005; Overbeek et al., 2006; Ritakallio et al., 2008; Vieno, Kiesner, Pastore & Santinello, 2008). Indeed, ample research has found a clear association between internalizing and externalizing problems in adolescents (for a review see Boylan, Vaillancourt, Boyle & Szatmari, 2007). However, adolescence as a developmental stage is marked by substantial fluctuation in both the expression and severity of problem behavior (Angold & Costello, 1995; Costello et al., 2003; Hudziak, Achenbach, Althoff & Pine, 2007). It is therefore not surprising that the level of problems were found to vary, as well as the domains in which problems arise during adolescence (Burt, Obradovic, Long & Masten, 2008; Denissen, Asendorpf & Van Aken, 2008; Hutteman, Denissen, Asendorpf & Van Aken, 2009). Although studies have investigated longitudinal pathways of co-occurring internalizing and externalizing problems (e.g. Fergusson, Lynskey & Horwood, 1996; Masten et al., 2005; Ritakallio et al., 2008; Burt et al., 2008; Hutteman et al., 2009; Fanti & Henrich, 2010), only few studies specifically focused on the stability of the strength of the associations between internalizing and externalizing problems over time in adolescence. The few studies that have been investigating strength and stability of these co-occurring problems reported mixed results. Tolan and Henry (1996) found that rates of co-occurrence Proefschrift 10juli_final.indd 75 10-07-2013 22:43:02