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Health Promotion International, Vol. 17, No. 2, 139-146, June 2002
© Oxford University Press 2002

Externalizing and internalizing problems at school as signs of health-damaging behaviour and incipient marginalization

Eila Laukkanen, Sirpa Shemeikka1, Irma-Leena Notkola2, Heli Koivumaa-Honkanen and Aulikki Nissinen1

Department of Psychiatry, Kuopio University Hospital, PO Box 1777, 70211 Kuopio, 1 Department of Public Health and General Practice, University of Kuopio, PO Box 1627, 70211 Kuopio and 2 Department of Sociology, University of Helsinki, PO Box 18, 00014 Helsinki, Finland

Address for correspondence: Eila Laukkanen Department of Psychiatry (3703) Kuopio University Hospital PO Box 1777 FIN-70211 Kuopio Finland E-mail: eila.laukkanen{at}kuh.fi

This study aimed to investigate whether behavioural or emotional problems in adolescents detected by their teachers are signs of a common psychosocial maladjustment and of the beginning of social marginalization. Altogether, 171 pupils (15 years of age) from the eastern part of Finland participated in the survey. Behavioural and emotional problems and academic achievements were assessed separately by two teachers. Pupils filled in a questionnaire about alcohol use, smoking, physical exercise and fitness, self-rated health, psychosomatic symptoms, social relationships and future educational plans. Results showed that poor success at school and the absence of or limited educational plans were associated with both externalizing and internalizing problems. Externalizing problems were associated with health-damaging behaviour and with bullying others. Internalizing problems were associated with poor perceived health and a low level of exercise, with mental symptoms, and with problems in social relationships. Thus, the pupils in both problem groups had a clustering of different risk factors. We conclude that the accumulation in adolescents of self-reported health-damaging behaviour, problems related to school, to future educational plans and to social relationships are already obvious in pupils with externalizing and/ or internalizing problems detected by their teachers at the age of 15 years. The capacity of teachers to identify pupils at risk as early as possible should therefore be utilized. The development of a vicious circle might be prevented through early intervention at school, by offering pupils guidance, counselling and treatment.

Key words: adolescence; behavioural problems; health habits; marginalization


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