Skip to main content
Log in

Facing Death in Adolescence: What Leads to Internalization and Externalization Problems?

  • ORIGINAL ARTICLE
  • Published:
Journal of Child & Adolescent Trauma Aims and scope Submit manuscript

Abstract

The aim of this study was to test a model to better explain which factors are linked to the development of internalized and externalized problems in adolescents experiencing death through structural equation model. Internalizing problems were predicted by low self-esteem, high PTSD symptomatology and by being a female, whereas externalizing problems were predicted by low self-esteem, by the experience of the loss as central in their own life and by being a male. Our results pointed out the potential importance of controlling this factors in order to provide focused interventions for adolescents after the death of a significant one.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Achenbach, T. M. (1991). Manual for the Child Behavior Checklist/4-18 and 1991 profile (p. 288). Burlington: Department of Psychiatry, University of Vermont.

  • Adams, G. R., & Berzonsky, M. (Eds.). (2008). Blackwell handbook of adolescence (Vol. 8). Wiley.

  • Alisic, E., van der Schoot, T. A., van Ginkel, J. R., & Kleber, R. J. (2008). Trauma exposure in primary school children: Who is at risk? Journal of Child & Adolescent Trauma, 1(3), 263–269.

    Article  Google Scholar 

  • Arbuckle, J. (2003). Amos 5.0 update to the Amos user’s guide. Marketing Department, SPSS incorporated.

  • Berntsen, D., & Rubin, D. C. (2006). The centrality of event scale: A measure of integrating a trauma into one's identity and its relation to post-traumatic stress disorder symptoms. Behaviour Research and Therapy, 44(2), 219–231.

    Article  PubMed  PubMed Central  Google Scholar 

  • Berntsen, D., & Rubin, D. C. (2007). When a trauma becomes a key to identity: Enhanced integration of trauma memories predicts posttraumatic stress disorder symptoms. Applied Cognitive Psychology, 21(4), 417–431.

  • Boals, A., & Schuettler, D. (2011). A double-edged sword: Event centrality, PTSD and posttraumatic growth. Applied Cognitive Psychology, 25(5), 817–822.

    Article  Google Scholar 

  • Boelen, P. A. (2009). The centrality of a loss and its role in emotional problems among bereaved people. Behaviour Research and Therapy, 47(7), 616–622.

    Article  PubMed  Google Scholar 

  • Boelen, P. A., & Spuij, M. (2013). Symptoms of post-traumatic stress disorder in bereaved children and adolescents: Factor structure and correlates. Journal of Abnormal Child Psychology, 41(7), 1097–1108.

    Article  PubMed  Google Scholar 

  • Boelen, P. A., van den Bout, J., & van den Hout, M. A. (2003). The role of cognitive variables in psychological functioning after the death of a first degree relative. Behaviour Research and Therapy, 41(10), 1123–1136.

    Article  PubMed  Google Scholar 

  • Boelen, P. A., van den Bout, J., & van den Hout, M. A. (2006). Negative cognitions and avoidance in emotional problems after bereavement: A prospective study. Behaviour Research and Therapy, 44(11), 1657–1672.

    Article  PubMed  Google Scholar 

  • Bowlby, J. (1969). Attachment and loss: Vol. 1. Loss. Nueva York: Basic Books.

    Google Scholar 

  • Breslau, N., Wilcox, H. C., Storr, C. L., Lucia, V. C., & Anthony, J. C. (2004). Trauma exposure and posttraumatic stress disorder: A study of youths in urban America. Journal of Urban Health, 81(4), 530–544.

    Article  PubMed  PubMed Central  Google Scholar 

  • Coleman, J. C., & Hendry, L. (1990). La natura dell’adolescenza, il Mulino.

  • Dowdney, L. (2000). Annotation: Childhood bereavement following parental death. Journal of Child Psychology and Psychiatry, 41(07), 819–830.

    Article  PubMed  Google Scholar 

  • Draper, A., & Hancock, M. (2011). Childhood parental bereavement: The risk of vulnerability to delinquency and factors that compromise resilience. Mortality, 16(4), 285–306.

    Article  Google Scholar 

  • Erikson, E. H. (1963). Childhood and society. The landmark work on the social significance of childhood. New York: Norton.

    Google Scholar 

  • Field, N. P., Gal-Oz, E., & Bonanno, G. A. (2003). Continuing bonds and adjustment at 5 years after the death of a spouse. Journal of Consulting and Clinical Psychology, 71(1), 110.

  • Gersten, J. C., Beals, J., & Kallgren, C. A. (1991). Epidemiology and preventive interventions: Parental death in childhood as a case example. American Journal of Community Psychology, 19(4), 481–500.

    Article  PubMed  Google Scholar 

  • Grant, K. E., Compas, B. E., Stuhlmacher, A. F., Thurm, A. E., McMahon, S. D., & Halpert, J. A. (2003). Stressors and child and adolescent psychopathology: Moving from markers to mechanisms of risk. Psychological Bulletin, 129(3), 447.

    Article  PubMed  Google Scholar 

  • Gray, L. B., Weller, R. A., Fristad, M., & Weller, E. B. (2011). Depression in children and adolescents two months after the death of a parent. Journal of Affective Disorders, 135(1), 277–283.

    Article  PubMed  Google Scholar 

  • Habermas, T., & Bluck, S. (2000). Getting a life: The emergence of the life story in adolescence. Psychological Bulletin, 126(5), 748.

    Article  PubMed  Google Scholar 

  • Haine, R. A., Ayers, T. S., Sandler, I. N., Wolchik, S. A., & Weyer, J. L. (2003). Locus of control and self-esteem as stress-moderators or stress-mediators in parentally bereaved children. Death Studies, 27(7), 619–640.

    Article  PubMed  Google Scholar 

  • Harrison, L., & Harrington, R. (2001). Adolescents' bereavement experiences. Prevalence, association with depressive symptoms, and use of services. Journal of adolescence, 24(2), 159–169.

  • Ionio, C., Olivari, M. G., & Confalonieri, E. (2013). Eventi traumatici in adolescenza: Risposte psicologiche e comportamentali. Maltrattamento e abuso all’infanzia, 15(2), 87–99.

    Google Scholar 

  • Ivarsson, T., Gillberg, C., Arvidsson, T., & Broberg, A. G. (2002). The youth self-report (YSR) and the depression self-rating scale (DSRS) as measures of depression and suicidality among adolescents. European Child & Adolescent Psychiatry, 11(1), 31–37.

    Article  Google Scholar 

  • Johansen, V. A., Wahl, A. K., Eilertsen, D. E., & Weisaeth, L. (2007). Prevalence and predictors of post-traumatic stress disorder (PTSD) in physically injured victims of non-domestic violence. Social Psychiatry and Psychiatric Epidemiology, 42(7), 583–593.

    Article  PubMed  Google Scholar 

  • Kranzler, E. M., Shaffer, D., Wasserman, G., & Davies, M. (1990). Early childhood bereavement. Journal of the American Academy of Child & Adolescent Psychiatry, 29(4), 513–520.

    Article  Google Scholar 

  • Luecken, L. J., & Roubinov, D. S. (2012). Pathways to lifespan health following childhood parental death. Social and Personality Psychology Compass, 6(3), 243–257.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lutzke, J. R., Ayers, T. S., Sandler, I. N., & Barr, A. (1997). Risks and interventions for the parentally bereaved child. In Handbook of children’s coping (pp. 215–243). Springer US.

  • Mack, K. Y. (2001). Childhood family disruptions and adult well-being: The differential effects of divorce and parental death. Death Studies, 25(5), 419–443.

    Article  PubMed  Google Scholar 

  • Mash, H. B. H., Fullerton, C. S., Shear, M. K., & Ursano, R. J. (2014). Complicated Grief & Depression in young adults: Personality & Relationship Quality. The Journal of Nervous and Mental Disease, 202(7), 539.

    Article  PubMed  Google Scholar 

  • Melhem, N. M., Day, N., Shear, M. K., Day, R., Reynolds, C. F., & Brent, D. (2004). Predictors of complicated grief among adolescents exposed to a peer's suicide. Journal of Loss and Trauma, 9(1), 21–34.

    Article  Google Scholar 

  • Melhem, N. M., Moritz, G., Walker, M., Shear, M. K., & Brent, D. (2007). Phenomenology and correlates of complicated grief in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 46(4), 493–499.

    Article  Google Scholar 

  • Melhem, N. M., Walker, M., Moritz, G., & Brent, D. A. (2008). Antecedents and sequelae of sudden parental death in offspring and surviving caregivers. Archives of Pediatrics & Adolescent Medicine, 162(5), 403–410.

  • Ogle, C. M., Rubin, D. C., & Siegler, I. C. (2013). The impact of the developmental timing of trauma exposure on PTSD symptoms and psychosocial functioning among older adults. Developmental Psychology, 49(11), 2191.

    Article  PubMed  Google Scholar 

  • Oransky, M., Hahn, H., & Stover, C. S. (2013). Caregiver and youth agreement regarding youths’ trauma histories: Implications for youths’ functioning after exposure to trauma. Journal of Youth and Adolescence, 42(10), 1528–1542.

    Article  PubMed  Google Scholar 

  • Pietrantonio, F., De Gennaro, L., Di Paolo, M. C., & Solano, L. (2003). The Impact of Event Scale: validation of an Italian version. Journal of Psychosomatic Research, 55(4), 389–393.

  • Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Aslan, M., Goodkin, K., et al. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Medicine, 6(8), e1000121.

    Article  PubMed  PubMed Central  Google Scholar 

  • Qouta, S., Punamäki, R. L., & El Sarraj, E. (2005). Mother-child expression of psychological distress in war trauma. Clinical Child Psychology and Psychiatry, 10(2), 135–156.

    Article  Google Scholar 

  • Reinherz, H. Z., Giaconia, R. M., Hauf, A. M. C., Wasserman, M. S., & Silverman, A. B. (1999). Major depression in the transition to adulthood: Risks and impairments. Journal of Abnormal Psychology, 108(3), 500.

    Article  PubMed  Google Scholar 

  • Rosenberg, M. (1965). Society and the adolescent self-image. Princeton: Princeton University Press.

    Book  Google Scholar 

  • Raveis, V. H., Siegel, K., & Karus, D. (1999). Children's psychological distress following the death of a parent. Journal of Youth and Adolescence, 28(2), 165–180.

  • Sandler, I., Ayers, T. S., Tein, J. Y., Wolchik, S., Millsap, R., Khoo, S. T., et al. (2010). Six-year follow-up of a preventive intervention for parentally bereaved youths: A randomized controlled trial. Archives of Pediatrics & Adolescent Medicine, 164(10), 907–914.

    Article  Google Scholar 

  • Schmiege, S. J., Khoo, S. T., Sandler, I. N., Ayers, T. S., & Wolchik, S. A. (2006). Symptoms of internalizing and externalizing problems: Modeling recovery curves after the death of a parent. American Journal of Preventive Medicine, 31(6), 152–160.

    Article  Google Scholar 

  • Silverman, P. R., & Worden, J. W. (1992). Children's reactions in the early months after the death of a parent. American Journal of Orthopsychiatry, 62(1), 93–104.

  • Stikkelbroek, Y., Bodden, D. H., Reitz, E., Vollebergh, W. A., & van Baar, A. L. (2016). Mental health of adolescents before and after the death of a parent or sibling. European Child & Adolescent Psychiatry, 25(1), 49–59.

    Article  Google Scholar 

  • Stinson, K. M., Lasker, J. N., Lohmann, J., & Toedter, L. J. (1992). Parents' grief following pregnancy loss: A comparison of mothers and fathers. Family Relations, 218–223.

  • Stroebe, W., Zech, E., Stroebe, M. S., & Abakoumkin, G. (2005). Does social support help in bereavement? Journal of Social and Clinical Psychology, 24(7), 1030–1050.

    Article  Google Scholar 

  • Thapar, A., Collishaw, S., Pine, D. S., & Thapar, A. K. (2012). Depression in adolescence. The Lancet, 379(9820), 1056–1067.

    Article  Google Scholar 

  • Trzesniewski, K. H., Donnellan, M. B., Moffitt, T. E., Robins, R. W., Poulton, R., & Caspi, A. (2006). Low self-esteem during adolescence predicts poor health, criminal behavior, and limited economic prospects during adulthood. Developmental Psychology, 42(2), 381.

    Article  PubMed  Google Scholar 

  • Ursano, R. J. (2014). Complicated grief and depression in young adults. J Nerv Ment Dis, 202, 00Y00.

  • Weiss, D. S., & Marmar, C. R. (1997). The impact of event scale-revised. In J. P. Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD (pp. 399–411). New York: Guilford Press.

    Google Scholar 

  • Weller, R. A., & Weller, E. B. (1991). Depression in recently bereaved prepubertal children. The American Journal of Psychiatry, 148(11), 1536.

  • Wolchik, S. A., Tein, J. Y., Sandler, I. N., & Ayers, T. S. (2006). Stressors, quality of the child–caregiver relationship, and children's mental health problems after parental death: The mediating role of self-system beliefs. Journal of Abnormal Child Psychology, 34(2), 212–229.

    Article  Google Scholar 

  • Worden, J. W., & Silverman, P. R. (1996). Parental death and the adjustment of school-age children. OMEGA-Journal of Death and Dying, 33(2), 91–102.

    Article  Google Scholar 

  • Wortmann, J. H., & Park, C. L. (2008). Religion and spirituality in adjustment following bereavement: An integrative review. Death Studies, 32(8), 703–736.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Chiara Ionio.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Standards and Informed Consent

The study have been approved by the University Ethics Committee and have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All parents gave their informed consent for their children prior to their inclusion in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ionio, C., Camisasca, E., Milani, L. et al. Facing Death in Adolescence: What Leads to Internalization and Externalization Problems?. Journ Child Adol Trauma 11, 367–373 (2018). https://doi.org/10.1007/s40653-017-0166-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40653-017-0166-8

Keywords

Navigation