Internalizing symptoms and disorders in families of adolescents: A review of family systems literature

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Abstract

Internalizing symptoms and disorders are relatively common during adolescence and impact considerably on social and emotional functioning. Using a family systems framework, this paper reviews the current literature examining the impact of internalizing symptoms and disorders on the functioning of the family system, the spouse subsystem and the parent–child subsystem. Moreover, literature examining the relationship between parents' and adolescents' internalizing symptoms and disorders is reviewed. The reviewed research demonstrates that there exists an association between internalizing symptoms and disorders and poorer functioning at various levels of the family system. Longitudinal studies have generally reported that parent internalizing symptoms and disorders predict poorer functioning in the family system as well as internalizing symptoms and disorders in adolescents. However, few longitudinal studies have examined whether adolescent internalizing symptoms and disorders predict poorer family functioning and internalizing symptoms and disorders in parents. Those that have examined such effects report mixed results. On the basis of our review, we make recommendations about future research directions. In particular, it is argued that more research on the reciprocal effects of internalizing symptoms and disorders within families is needed to better understand the antecedents and consequences of these conditions for families of adolescents.

Section snippets

The current review

This paper reviews the current literature on internalizing symptoms and disorders in families of adolescents within a family systems framework. While much of the literature emphasizes the effect that parents and families have on the well-being of adolescents, this review aims to highlight the importance of considering possible reciprocal effects between parents, adolescents, and their families.

The majority of research examining associations between family climate and internalizing symptoms and

Family systems theory

Extrapolating from theories frequently applied to biological and social systems, family systems theory conceptualizes the family as an organized whole in which all the elements (i.e., members) are interdependent (Minuchin, 1985). Thus, an individual's behavior is viewed as being strongly influenced and determined by the structure, organization, and transactional patterns of the family system (Miller, Ryan, Keitner, Bishop, & Epstein, 2000). Likewise, the characteristics and behavior of all

Family system

Family functioning refers to the family's ability to deal with everyday life and cope effectively with problems and changes. Researchers and theorists have included various aspects of family life and relationships in their conceptualizations of family functioning which have been assessed via various self-report and observational measures. These aspects include, but are not limited to, communication, conflict, cohesion, affective expression, roles, behavioral control, adaptability, and

Family system

In line with research on parents, research on families of adolescents with internalizing symptoms and disorders has generally reported that family dysfunction is common. However, much of this research has focused solely on depression, with anxiety being once again relatively neglected.

In general, adolescent depressive symptoms and disorders are reported to be related to both overall family dysfunction (McFarlane et al., 1995, Tamplin et al., 1998; see Table 1) and to specific aspects of family

Reciprocal effects in the family system

From the research presented thus far it can generally be concluded that parent and adolescent internalizing symptoms and disorders are associated with poorer family functioning, poorer marital relationships, more negative parenting behaviors, poorer quality of attachment, and higher rates of parent/adolescent psychopathology. However, the main limitation of this research is that the majority of findings are based on correlational designs. While virtually all authors caution that the direction

Limitations

There are a number of limitations in the current literature on the effects of internalizing symptoms and disorders in families. The two main limitations which have already been discussed are the limited interpretation possible from correlational studies and the paucity of studies examining reciprocal effects. However, there are additional limitations. The first relates to the large number of measures and methods that have been utilized to study internalizing symptoms and disorders and various

Summary and conclusions

By presenting the findings from studies of internalizing symptoms and disorders in families of adolescents from a family systems perspective, this review has aimed to highlight the need for future research to more fully consider possible reciprocal effects in families. Despite some important limitations, there is considerable evidence in the current literature to suggest that parent and adolescent internalizing symptoms and disorders are associated with poorer functioning at various levels of

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