Co-Developmental Trajectories of Parental Psychological Distress and Child Internalizing and Externalizing Problems in Childhood and Adolescence: Associations with Self-Harm and Suicide Attempts

Abstract

Growing evidence has suggested that parental mental illness and child internalizing and externalizing problems tend to co-occur and engender risk for adverse child outcomes; however, there is considerable heterogeneity in their joint developmental trajectories. This study aimed to evaluate the joint developmental trajectories of maternal and paternal psychological distress and child internalizing and externalizing problems from early childhood to middle adolescence. Given that suicide and self-harm are major public health issues in adolescence and often occur in the context of other mental health issues, we also examined the association between these joint trajectories and these outcomes in adolescence. Parallel-process latent class growth analysis was applied to 14 years of follow-up data from a large-scale, nationally representative sample of youths participating in the UK’s Millennium Cohort Study (MCS; n = 12,520, 50.9% male). Results showed the best-fitting solution had four trajectory classes: (1) low symptoms, 59.0%; (2) moderate symptoms in children, 22.5%; (3) notable symptoms in fathers, 10.7%; and (4) co-occurring maternal and child symptoms, 7.8%. The trajectory groups differed in their self-harm and suicide attempts in adolescence, underscoring the possible importance of the roles of both parental distress and child problem behaviors processes in these outcomes. Future studies will be valuable to rigorously test the directionality and the respective roles of parents and children in this association. Our findings suggest the need for two-generation mental health intervention programs that are tailored based on co-developmental trajectory group membership.

Association between developmental patterns of single and concurrent externalizing behaviors and internalizing problems over the preschool years.

“…Results showed that children in the high-HI + NC + PA trajectory class suffered the highest number of negative outcomes. These findings are in line with other studies examining later social maladjustment in youth with co-occurring externalizing and internalizing problems (Dugré et al, 2020; Fanti & Henrich, 2010; Murray et al, 2022; Vergunst et al, 2023; Winsper et al, 2020; Zhu et al, 2023). As those studies’ trajectories spanned from preschool to adolescence (i.e., age 2–16), children following high EBs trajectories with co-occurring internalizing problems already during the preschool years are likely at risk of similar problems.…”

“…The aim of the present study was to investigate whether distinct developmental EBs patterns are concurrently and possibly differentially associated with three facets of internalizing problems (i.e., general anxiety, separation anxiety, and depressive symptoms) throughout the preschool years in a population birth cohort. As expected, findings concord with prior reports that internalizing problems are positively associated with EBs (Dugré et al, 2020; Fanti & Henrich, 2010; Girard, 2021; Goulter et al, 2021; Morales et al, 2024; Murray et al, 2022; Speyer et al, 2022; Vergunst et al, 2023; Winsper et al, 2020; Zhu et al, 2023). Specifically, higher levels of general anxiety, separation anxiety, and depressive symptoms from the early to late preschool years were observed in children following high EBs trajectories, when compared to their peers who followed a low or moderate trajectory for all EBs across the preschool years.…”

“…As noted earlier, this absence of sex difference is consistent with previous reports on externalizing and internalizing association in preschoolers (Mahendran et al, 2021; Wang & Yan, 2019). Moreover, although none of the reviewed population studies focused specifically on the preschool period, the two studies that reported no sex difference in co-occurring externalizing and internalizing classes included some preschool measures (Goulter et al, 2021; Zhu et al, 2023). In another study of externalizing and internalizing symptoms at ages 3–14 years, Papachristou and Flouri (2020) reported no sex differences in the growth parameters (i.e., intercept at age 3 and slope) of the externalizing and internalizing symptom growth curves.…”

“…While population-based studies are essential to assess the presence and strength of the association between disorders (Angold et al, 1999), relatively few used a person-centered approach to examine the developmental co-occurrence of externalizing and internalizing problems. The few exceptions mainly used global measures of the two broad categories (Dugré et al, 2020; Fanti & Henrich, 2010; Girard, 2021; Goulter et al, 2021; Morales et al, 2024; Murray et al, 2022; Nivard et al, 2017; Patalay et al, 2017; Speyer et al, 2022; Vergunst et al, 2023; Winsper et al, 2020; Zhu et al, 2023). Evidence of developmental co-occurrence has been primarily based on a trajectory class of individuals showing higher levels of both types of problems over time.…”

A network approach to the investigation of childhood irritability: probing frustration using social stimuli

“…In order to characterize the normative temperamental and clinical features of the sample, parents/guardians of the participants completed two measures: the Child Behavior Questionnaire -Short Form (CBQ; Putnam & Rothbart, 2006) and the Multidimensional Assessment Profiles (MAPS; Krogh-Jespersen et al, 2022;Zhang et al, 2023). The anger/ frustration subscale of the CBQ is six items and was used as a measure of irritable temperament, consistent with previous studies (Fishburn et al, 2019;Karim & Perlman, 2017;Silver et al, 2023).…”