Interpersonal Problems as Mediator Between Parental Rearing Styles and Internalizing-Externalizing Problems in Adolescents

Received 09 Dec, 2020

Accepted 21 Apr, 2021

Published 30 Sep, 2021

The mental health of youth is considered a big challenge in recent years for mental health professionals. Adolescents are known to have an increased prevalence of internalizing-externalizing problems that lead to adverse social, academic, and personal outcomes. This research is investigating the role of interpersonal problems as the mediator in the association of parental warmth and rejection with internalizing-externalizing problems in 732 adolescents (girls = 49%, boys = 51%) recruited through multistage sampling technique. Measures included Egna Minnen Betraffande Uppostran for Children (EMBU-C) (Saleem, Mahmood, & Subhan, 2015), the Youth version of the Child Behavior Checklist (Achenbach & Rescorla, 2001), and the Interpersonal Difficulties Scale (Zahra & Saleem, 2020). Correlation analysis confirmed the significant association among parental warmth, parental rejection, internalizing-externalizing problems, and interpersonal problems. Findings of mediation analysis revealed that parental warmth and parental rejection have effects on internalizing-externalizing problems via interpersonal problems. Implications are discussed in terms of the counseling of adolescents.

Parents play a significant and productive contribution to the psychological, interpersonal, and emotional growth and development of their children (Mouton, Loop, Stievenart, & Roskam, 2018; Wong, Zhuang, & Ng, 2019; Zahra & Saleem, 2021b). Positive parenting is characterized by providing emotional warmth, affection, and care and is likely to associate with the overall adjustment and well-being of adolescents and children (Afia, Dion, Dupere, Archambault, & Toste, 2019; Filus, Schwarz, Mylonas, Sam, & Boski, 2019; Wong et al., 2019). On the other hand, low parental emotional responsiveness, and communication, controlling, punitive, rejecting, and harsh parenting is associated with adverse consequences including depression, anxiety, stress, aggression, social isolation, loneliness, substance use, and self-injurious behaviors (Haslam, Poniman, Filus, Sumargi, & Boediman, 2020; King, Boyd, & Pragg, 2017; Yurasek et al., 2019). Researchers explored that parenting styles have a significant impact on adolescents’ adjustment and subsequent development of internalizing-externalizing problems (Aytac, Pike, & Bond, 2019; McErlean & Lim, 2020; McKinney & Kwan, 2018; Shim & Lim, 2019; Zubizarreta, Calvete, & Hankin, 2019). Bowlby (1973) also emphasized the parent-child emotional bonding and its influence on the psychosocial functioning, interpersonal relationships, and well-being of children and adolescents (Haslam et al., 2020; McErlean & Lim, 2020). Similarly, Rohner (1986) posited that a higher level of parental warmth and parental acceptance is likely to link with several positive outcomes like well-being, quality of life, school performance, psychological adjustment, and lower level of internalizing-externalizing problems (Rohner, 2004; Ruiz, Carrasco, & Holgado-Tello, 2019; Shim & Lim, 2019). On the other hand, a higher level of parental rejection and control is associated with adverse outcomes like social incompetence, interpersonal problems, low self-esteem, social isolation, loneliness, and higher internalizing-externalizing problems (Pinquart, 2016; Wang et al., 2018; Zahra & Saleem, 2021a).

The adolescence period is marked by many rapidly changing social and emotional world including changing gender role identification, pubertal changes, increased parental involvement and expectations, and defining the unique sense of identity (Erikson, 1968; Ma, Siu, & Tse, 2018; Zahra, Saleem, Subhan, & Mahmood, 2021) and these demands and expectations increase the risk for developing internalizing-externalizing problems in adolescents (Saleem & Mahmood, 2011) which lead to poor academic achievement, high dropout rate, social incompetence and difficulties, low self-esteem, loneliness, and lower level of well-being in future (Agh et al., 2016; Kumar, 2019; Polanczyk, Salum, Sugaya, Caye, & Rohde, 2015; Selamu & Singhe, 2018; Sutherland, 2018; Wagner et al., 2017). Therefore, if these internalizing-externalizing problems are not addressed and handled at the initial stages, may lead to serious emotional, psychological, behavioral, and academic dysfunctionality and later pathologies (McLaughlin et al., 2015). Furthermore, the research evidence also suggested that a large number of adolescents are experiencing serious internalizing-externalizing problems having the prevalence rate of 13% to 67% with the predominance of internalizing problems (Keyho et al., 2019; Kumar, Bhilwar, Kapoor, Sharma, & Parija, 2016; Nair, Ganjiwale, Kharod, Varma, & Nimbalkar, 2017; Polanczyk et al., 2015; Saleem & Mahmood, 2011; Wagner et al., 2017). With the alarming rate of prevalence, contemporary research is now focused on exploring the risk and protective factors through which we can prevent adolescents from internalizing-externalizing problems.

The expansion of the social world and developing interpersonal relationships is another developmental task of adolescence (Mestre, Carlo, Samper, Malonda, & Mestre, 2019; Zahra et al., 2021). Physical maturity increased autonomy, perspective-taking, and learning of moral reasoning allow adolescents to expand social interaction and develop dynamic relationships (Bester, 2019; Bowlby, 1973). Vygotsky (1978) postulated that social interaction is essential for children's development to acquire acceptable and new social skills and behaviors. Successful adjustment to the social world assists adolescents in the development of new interpersonal skills that facilitate social growth and development (Backman, Laajasalo, Jokela, & Aronen, 2018; Jhang, 2017; Zahra et al., 2021). However, failure in learning new social skills leads them towards numerous personal, interpersonal, and emotional problems (Elsina & Martinsone, 2020; Hamilton et al., 2016). Many researchers identified that interpersonal problems in adolescents are associated with have numerous negative outcomes (Hopwood & Good, 2018) including less class participation, poor academic performance, lack of initiative, loneliness, and greater mental health problems (Elsina & Martinsone, 2020; Huang, Liu, & Yu, 2016; Joybari, 2014; Razali, 2017; Yang et al., 2020). Numerous pieces of research also proposed that interpersonal problems are associated with a higher level of internalizing-externalizing problems in adolescents (Byrd & Mckinney, 2012; Masselink, & Roekel, Oldehinkel, 2018; Saleem, Asghar, Subhan, & Mahmood, 2019).

Research evidence also indicated that warm, compassionate, and supportive parents have a key role in the development of interpersonal and social skills and social competence (Jeon & Nepple, 2019; Leidy, Guerra, & Toro, 2010) However, punitive, controlling, and rejecting parents significantly contribute in the development of interpersonal and social difficulties in children (Saleem et al., 2019). Skinner (1969) and Bandura (1992) claim that children learn faulty behaviors through modeling and imitating socially deviant models at home, school, and social groups. Bowlby (1982) also posited parental attachment as the basic biological need that is essential for the survival of the children and they develop an internal model based on the emotional bond with primary caregivers like mothers which consequently influence the social relationships of the children.

To conclude adolescence is the most critical developmental period during which an individual learns emotional and social skills to cope with the challenges of this transitory period. Increased prevalence of mental health issues has attained the focus of researchers to explore the protective and risk factors of internalizing-externalizing problems in adolescents. Therefore, the existing study was aimed at identifying the role of parental rearing styles, and interpersonal problems in internalizing-externalizing problems in Pakistani adolescents. Pakistan is a collectivistic society in which familial values, norms, conformity, and cohesion are preferred (An & Eggum-Wilkens, 2019; Germani, Delvecchio, & Mazzeschi, 2020; Nadeem, Mahmood, & Saleem, 2018; Zahra & Saleem, 2021a). In this socio-cultural environment, the role of parents becomes even more crucial which demonstrates a long-lasting effect on growth and development (Saleem, Mahmood, & Daud, 2017). Furthermore, in Pakistan the childhood period is long and parents have the authority to make life decisions for children (Dwairy, 2010; Saleem, Ihsan, & Mahmood, 2014; Saleem et al., 2015). This parental and familial control and dominance inhibit children to learn skills to deal and interact with others, especially, outdoor in the family (An & Eggum-Wilkens, 2019; Triandis, 2001). Therefore, children and adolescents are at higher risk for developing numerous difficulties in interpersonal and social relationships.

The existing research was aimed to identify the relationship of parental rearing styles, interpersonal problems, and internalizing-externalizing problems in adolescents, and also to explore the role of interpersonal problems as the mediator in the relationship of parental rearing styles with internalizing-externalizing problems in adolescents.

METHOD

Participants
Sample size for this study was 732 adolescents (boys = 51%, girls = 49%) studying in grade 8^th (31%), 9^th (35%), and 10^th (34%) having the age range of 12 to 19 years (M = 14.40; SD =1.29). Participants were selected from 7 mainstreams government schools of Lahore, Pakistan. Participants were recruited through a multistage sampling strategy. At the first stage, two strata were made i.e., boys and girls, and in the second stage, by considering the academic grade of the participants three substrata were made i.e., 8^th, 9^th, and 10^th. Being an only child and single-parent children were excluded from this study.

Measures
Egna Minnen Betraffande Uppostran for Children (EMBU-C). Urdu version (Saleem et al., 2015) of EMBU-C (Muris et al., 2003) was used to assess parental (father and mother) rearing styles. The scale is comprised of 39items having a 4-point rating scale ranging from 0 (not at all) to 3 (very much). The scale is comprised of four parental rearing practices parental warmth (10 items), rejection (9 items), overprotection(10 items), and anxious rearing(10 items) assessing the father’s and mother’s rearing behaviors separately. The total score of each item on the scale ranged from 0 to 117.Cronbach's alpha of father warmth (α = ­­­.72), father rejection (α = .73), father overprotection (α = .70), father anxious rearing (α = .71), total EMBU-CF (α = .76), mother warmth (α = ­­­.70), mother rejection (α = .71), mother overprotection (α = .72), mother anxious rearing (α = .73), and total EMBU-CM (α = .80) for existing research suggesting that the scale has good internal consistency for existing study.

Child Behavior Checklist (Youth Self Report-YSR). The youth version (YSR) of the Child Behavior Checklist (CBCL) (Achenbach & Rescorla, 2001) was adapted in Urdu to measure the internalizing-externalizing problems of children. It has consisted of 112 items having a three-point rating scale from 0 (not at all) to 2 (often). Items consisted of two broad subscales named internalizing problems and externalizing problems including subscales withdrawn/depressed, anxious/depressed, somatic complaints, thought problems, social problems, attention problems, aggressive behavior, and rule-breaking behavior. Scores of YSR were ranged from 0-224. The Cronbach alpha of YSR for this study was (α = .93) representing sound internal consistency of YSR.

Interpersonal Difficulties Scale (IDS). Interpersonal problems of the participants were assessed through the Interpersonal Difficulties Scale (IDS) (Zahra & Saleem, 2020) consisted of 36 items consisting of a 5-point rating scale ranged from0 (not at all) to 4(always). IDS is comprised of three sub-scales lack of manners, social isolation, and self-centeredness. Scores of IDS were ranged from 0 to 144. Cronbach's alpha for lack of manners (α = .82), social isolation (α = .72), self-centredness (α = .70) and total IDS (α = .81) for existing study representing the good internal consistency of IDS.

PROCEDURE

Initially, the study was approved by the Institutional Review Board (IRB). After getting approval, the researcher visited the 7 schools of Lahore, Pakistan, and told the key aim of this study to the principals of the schools. After getting permission from principals, data were collected from 8^th, 9^th, and 10^th class students with each group having an average of 30 children. The final booklet of questionnaires was given merely to those children who were agreed to participate in the existing research. Participants have also assured the confidentiality of the data gained from them. The average time to complete the protocol was 25 minutes approximately.

Ethical Considerations
Significant research ethics were followed during data collection. First, a verbal agreement to participate in the research was carried out from participants. Second, participants were also informed that their involvement in the study is voluntary. Third, participants were fully allowed to quit from research at any point in time. Fourth, they have also given assurance of the confidentiality of the data taken from them and assured that their information will not be used for any purpose except research. Finally, the purpose of the research project was also briefed to them.

RESULTS

The relationships between parental rearing styles, interpersonal problems and internalizing-externalizing problems are reported in Table 1. Results depict significant negative relationship between father warmth and interpersonal problems (r = -.20, p < .001), father warmth and internalizing-externalizing problems (r = -.16, p < .001), mother warmth and interpersonal problems (r = -.12, p < .01), mother warmth and internalizing-externalizing problems (r = -.16, p < .001). Moreover, results also indicated significant positive correlation of father rejection and interpersonal problems (r = .34, p < .001), father rejection and internalizing-externalizing problems (r = .32, p < .001), mother rejection and interpersonal problems (r = .28, p < .001), mother rejection and internalizing-externalizing problems (r = .38, p < .001), interpersonal problems and internalizing-externalizing problems (r = .54, p < .001). However, findings also depicted that father overprotection, father anxious rearing, mother overprotection and mother anxious rearing are not significantly correlated with interpersonal problems (p > .05) and internalizing-externalizing problems (p > .05).

Table 1:	Inter-Correlations among Parental Warmth, Parental Rearing Styles, Interpersonal Problems and Internalizing-Externalizing Problems in Adolescents (N = 732)
Note. FW = Father Warmth; FR = Father Rejection; FOP = Father Over Protection; FAR = Father Anxious Rearing; MW = Mother Warmth; MR = Mother Rejection; MOP = Mother Over Protection; MAR = Mother Anxious Rearing; IPP = Interpersonal Problems; IEP = Internalizing Externalizing Problems ***p < .001, **p< .01, *p < .05, df = 731

Mediation Analysis
Correlation analysis indicated inter relatedness of parental warmth, parental rejection, interpersonal problems, and internalizing-externalizing problems. However, findings revealed that parental overprotection and parental anxious rearing are not significantly associated with interpersonal problems and internalizing-externalizing problems. Therefore, the mediation analysis was employed by using Hayes (2018) bootstrapping approach to find out the mediating role of interpersonal problems in the relationship of parental warmth and rejection with internalizing-externalizing problems.

Table 2:	Regression Coefficients, Standard Error, and Model Summary Information for the Father Warmth, Interpersonal Problems and Internalizing-Externalizing Problems of Adolescents (N=732)
Note. FW = Father Warmth, IPP = Interpersonal Problems, IEP= Internalizing-Externalizing Problems ***p < . 001, p >.05

Table 3:	Regression Coefficients, Standard Error, and Model Summary Information for the Mother Warmth, Interpersonal Problems and Internalizing Externalizing Problems of Adolescents (N=732) Note.MW = Mother Warmth, IPP = Interpersonal Problems, IEP= Internalizing-Externalizing Problems
***p < .001. **p < .01

Fig. 1: RMediation model of interpersonal problems (M) on the relationship between father warmth (X) and internalizing-externalizing problems (Y)

Fig. 2: Mediation model of interpersonal problems (M) on the relationship between mother warmth (X) and internalizing-externalizing problems (Y)

Figure 1 depicts significant total effect of father warmth on internalizing-externalizing problems (β = -.42, SE = .10, p < .001). Additionally, results also depicted the significant direct effects of father warmth on interpersonal problems (β = -.61, SE = .12, p < .001) and interpersonal problems on internalizing-externalizing problems (β = .48, SE = .03, p < .001). Results indicated that interpersonal problems fully mediate the relationship of father warmth and internalizing-externalizing problems because after controlling the interpersonal problems, the direct effect of father warmth on internalizing-externalizing problems is reduced to zero (β = -.13, SE = .09, p = .16) and c’ path is not significant. Furthermore, the indirect effect of father warmth on internalizing-externalizing problems through interpersonal problems was also significant (point estimate = -.29; 95% CI [LL = -.45, UL = -.16]), hence proving the interpersonal problems as mediators of father warmth and internalizing-externalizing problems.

Figure 2 depicts significant total effect of mother warmth on internalizing-externalizing problems (β = -.46, SE = .11, p < .001). Moreover, results also suggested significant direct effects of mother warmth on interpersonal problems (β = -.40, SE = .12, p < .01) and interpersonal problems on internalizing-externalizing problems (β = .46, SE = .03, p < .001). Interpersonal problems partially mediate the relationship of mother warmth and internalizing-externalizing problems after controlling the role of interpersonal problems, the direct effect of mother warmth on internalizing-externalizing problems is minimized (β = - .28, SE = .09, p < .01) but c’ path is still significant. In addition, the indirect effect of mother warmth on internalizing-externalizing problems through interpersonal problems was also significant (point estimate = - .18; 95% CI [LL = - .30, UL = - .07]). Therefore, we can conclude that interpersonal problems are significantly mediate mother warmth and internalizing-externalizing problems.

Table 4:	Regression Coefficients, Standard Error, and Model Summary Information for the Father Rejection, Interpersonal Problems and Internalizing-Externalizing Problems of Adolescents (N=732) Note.FR = Father Rejection, IPP = Interpersonal Problems, IEP= Internalizing-Externalizing Problems
***p < .001

Fig. 3: Mediation model of interpersonal problems (M) on the relationship between father rejection (X) and internalizing-externalizing problems (Y)

Figure 3 depicts the role of interpersonal problems as mediator in the relationship of father rejection and internalizing-externalizing problems. Findings depicts significant total effect of father rejection on internalizing-externalizing problems (β = 1.15, SE = .13, p < .001). Moreover, the results also revealed significant direct effects of father rejection on interpersonal problems (β = 1.41, SE = .15, p < .001) and interpersonal problems on internalizing-externalizing problems (β = .44, SE = .03, p < .001). Results indicated that interpersonal problems partially mediate the relationship of father rejection and internalizing-externalizing problems because after controlling the role of interpersonal problems, the direct effect of father rejection on internalizing-externalizing problems is minimized (β = .53, SE = .12, p < .001) but c’ path is significant. Furthermore, the indirect effect of father rejection on internalizing-externalizing problems through interpersonal problems was also significant (point estimate = .62; 95% CI [LL = .47, UL = .79]), hence proving the role of interpersonal problems as mediator in the association of father rejection and internalizing-externalizing problems.

Table 5:	Regression Coefficients, Standard Error, and Model Summary Information for the Mother Rejection, Interpersonal Problems and Internalizing-Externalizing Problems of Adolescents (N=732) Note. MR = Mother Rejection, IPP = Interpersonal Problems, IEP= Internalizing-Externalizing Problems
***p < .001

Fig. 4: Mediation model of interpersonal problems (M) on the relationship between mother rejection (X) and internalizing-externalizing problems (Y)

Figure 4 shows the interpersonal problems as mediator in mother rejection and internalizing-externalizing problems. Findings depicts significant total effect of mother rejection on internalizing-externalizing problems (β = 1.32, SE = .13, p < .001). Additionally, results also suggested significant direct effects of mother rejection on interpersonal problems (β = 1.15, SE = .15, p < .001) and interpersonal problems on internalizing-externalizing problems (β = .41, SE = .03, p < .001). Results revealed that interpersonal problems partially mediate the relationship of mother rejection and internalizing-externalizing problems because after controlling the role of interpersonal problems, the direct effect of mother rejection on internalizing-externalizing problems is minimized (β = .85, SE = .11, p < .001) but c’ path is significant. Additionally, the indirect effect of mother rejection on internalizing-externalizing problems through interpersonal problems was also significant (point estimate = .47; 95% CI [LL = .32, UL = .64]. Therefore, we can conclude that interpersonal problems are also significantly mediating the association of mother rejection and internalizing-externalizing problems.

Gender Differences on Parental Rearing Styles, Interpersonal Problems, and Internalizing-Externalizing Problems
Additionally, Independent sample t-test was employed to explore the gender differences in parental rearing styles, interpersonal problems, and internalizing-externalizing problems. Findings suggested significant gender differences in father over protection (t = 7.31, p < .001), father rejection (t = 3.38, p < .001), father anxious rearing (t = 4.32, p < .001), and interpersonal problems (t = 3.56, p < .001). Boys scored significantly higher on father over protection (M = 14.62, SD = 4.71), father rejection (M = 4.90, SD = 3.92), father anxious rearing (M = 20.10, SD = 4.87), and interpersonal problems (M = 43.10, SD = 16.58). However, no significant gender differences were found in father warmth, mother overprotection, mother warmth, mother rejection, mother anxious rearing, and internalizing-externalizing problems.

DISCUSSION

Adolescence is a period of bio-psycho-social development and growth that requires adjustment with ever-changing expectations and demands and failure in adjustment may lead adolescents to be at greater risk of internalizing-externalizing problems (Ma et al., 2018; Saleem & Mahmood, 2011). Throughout the world, numerous epidemiological studies suggested that a huge number of adolescents are experiencing internalizing-externalizing problems that are likely to be associated with adverse consequences (Kumar, 2019; Nair et al., 2017; Polanczyk et al., 2015; Selamu & Singhe, 2018). Therefore, the current research was aimed at exploring risk and protective factors that can prevent or increase internalizing-externalizing problems in adolescents.

Results of this study suggested that interpersonal problems significantly mediate the association of parental warmth and parental rejection with internalizing-externalizing problems in adolescents. Parents play a significant contribution to the personal, social, emotional, and psychological development of children (Filus et al., 2019; Zahra & Saleem, 2021b). Children do not only inherent physical features but also acquire and learn identity, values, interpersonal skills, self-esteem, and self-concept (Rohner, 2004; Shim & Lim, 2019). Affectionate, warmth, positive, caring, and supportive relationship with parents aids the children to develop aninternal model (Bowlby, 1982) which assist to provide a safe and secure base to build a sense of security and to develop healthy social interactions (Aytac et al., 2019; Backman et al., 2018; McErlean & Lim, 2020). Furthermore, parental warmth and acceptance may protect from internalizing-externalizing problems, however, parental rejection and control may lead to numerous internalizing-externalizing issues (Baumrind, 1966; Rohner, 1986). These results are also confirmed by literature that also suggested that positive parental relationships are significantly associated with fewer levels of social, interpersonal, behavioral, and emotional problems (McErlean & Lim, 2019; McKinney & Kwan, 2018; Shim & Lim, 2019).

Another developmental domain during adolescents is expanding the social world that requires social skills to adjust to social demands and challenges (Mestre et al., 2019). During this phase, living in an academically and socially competitive environment, dealing with authority, adolescents may experience numerous interpersonal problems that may lead adolescents towards numerous internalizing-externalizing problems in adolescents (Saleem et al., 2019). These findings are also consistent with previous empirical literature suggesting that interpersonal problems are positively correlated with internalizing-externalizing problems (Byrd & Mckinney, 2012; Masselink et al., 2018). During adolescence, there are numerous sources of learning socialization. Among them, warmth and affection ate parenting are considered the most significant source for developing social skills. However, parental rejection and control serve as a base for the development of numerous interpersonal problems (Jeon & Nepple, 2019; Leidy et al., 2010; Saleem et al., 2019). Parents are considered as the first and fundamental social interaction of an individual. Individuals acquire social functioning and interaction from parents by modeling and social learning process (Skinner, 1969). Social Learning Theory (Bandura, 1992) also claimed that observation of behaviors of significant members in the family might produce imitative behaviors from the children. Likewise, Bowlby (1973) specified that positive and secure parental attachment is positively linked with children’s effective and healthy social functioning. Furthermore, Pakistan is a collectivistic culture where parental dominance and control inhibit adolescents to learn social skills and more vulnerable to the development of interpersonal problems and difficulties.

Additionally, findings of this study depicted that boys scored high on father overprotection, father rejection, father anxious rearing, and interpersonal problems. These results are also supported by previous literature (Jenkins, Demaray, Fredrick, & Summers, 2016; Salavera, Usan, & Jarie, 2018). Furthermore, these findings also seem meaningful in terms of the Pakistani cultural context. In Pakistan, fathers are considered as an authoritative figure of the family and boys have a fewer attachment with their father than their mother. Moreover, they also spend more time outside the home as compared to girls therefore, fathers have to keep more check and balance on their activities. This might be the reason they scored high on father overprotection, father rejection, and father anxious rearing. Likewise, the family is the fundamental socialization agent for children to learn and acquire social and interpersonal skills. However, boys have less emotional warmth, closeness, and bonding with their families (Cano et al., 2017). They spend more time outside the home. Hence, they acquire fewer interpersonal skills and competence from the family that is considered crucial to develop and maintain social relationships, therefore, resulting in a higher level of interpersonal problems, manners, and social withdrawal.

Strengths and Limitations
The results of this study should be construed by considering the strengths and limitations. This research significantly contributed to the body of literature by exploring the role of parenting and interpersonal problems in internalizing-externalizing problems. Using a multi stage stratified random sampling strategy in the existing study yielded a representative sample. But the participants were recruited only from an urbanized population with a narrow age range which restricted the generalizability of this study. Upcoming studies should use both urban and rural samples with a broad age range. Furthermore, this study used self-report measures to collect data from adolescents. In the future triangular approach should be used to get children, parents, and teachers' views as all these resources would produce different types of information.

CONCLUSION

This paper yielded important information that overlays the way for exploring the role of parenting and interpersonal problems in internalizing-externalizing problems in an indigenous context.

REFERENCES

1. Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA School-Age form & profile. Burlington: University of Vermont Department of Psychiatry.
2. Afia, K., Dion, E., Dupere, V., Archambault, I., & Toste, J. (2019).Parenting practices during middle adolescence and high school dropout. Journal of Adolescence, 76, 55-64.
3. Agh, T., Kovacs, G., Supina, D., Pawaskar, M., Herman, B. K., Voko, Z., & Sheehan, D. V. (2016). A systematic review of the health-related quality of life and economic burdens of anorexia nervosa, bulimia nervosa, and binge eating disorder. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 21(3), 353-364.
4. An, D., & Eggum-Wilkens, N. D. (2019). Do cultural orientations moderate the relation between Chinese adolescents’ shyness and depressive symptoms? It depends on their academic achievement. Social Development, 28(4), 908-926.
5. Aytac, B., Pike, A., & Bond, R.(2019).Parenting and child adjustment: A comparison of Turkish and English families. Journal of Family Studies, 25(3),267-286.
6. Backman, H., Laajasalo, L. T., Jokela, M., & Aronen, E. T. (2018). Interpersonal relationships as protective and risk factors for psychopathy: A follow-up study in adolescent offenders. Journal of Youth and Adolescence, 47, 1022-1036.
7. Bandura, A. (1992). Perceived self-efficacy in cognitive development and functioning. Educational Psychologist, 28,117-148.
8. Baumrind, D. (1966). Effects of authoritative parental control on child behavior, Child Development, 37(4), 887-907.
9. Bester, G. (2019). Stress experienced by adolescents in school: The importance of personality and interpersonal relationships. Journal of Child and Adolescent Mental Health, 31(1), 25-37.
10. Bowlby, J. (1973). Separation, anxiety and anger. InAttachment and loss: Volume II: Separation, anxiety and anger(pp. 1-429). London: The Hogarth press and the institute of psycho-analysis.
11. Bowlby, J. (1982). Attachment and loss: Retrospect and prospect. American Journal of Orthopsychiatry, 52, 664-678.
12. Byrd, D. R., & McKinney, K. J. (2012). Individual, interpersonal, and institutional level factors associated with the mental health of college students.Journal of American College Health, 60(3), 185-193.
13. Cano, M. A., Sanchez, M., Rojas, P., Ramírez-Ortiz, D., Polo, K. L., Romano, E., & De La Rosa, M. (2017). Alcohol use severity among adult Hispanic immigrants: Examining the roles of family cohesion, social support, and gender. Substance Use and Misuse, 53(4), 668-676.
14. Dwairy, M. (2010). Introduction to special section on cross-cultural research on parenting and psychological adjustment of children. Journal of Child and Family Studies, 19, 1-7.
15. Elsina, I., & Martinsone, B. (2020). Interpersonal relationship aspects as perceived risk and social support factors in a clinical sample of adolescents with depression. Journal of Relationships Research, 11(1), 1-9.
16. Erikson, E. (1968). Identity: Youth and crisis. New York: Norton.
17. Filus, A., Schwarz, B., Mylonas, K., Sam, D. L., &Boski, P. (2019).Parenting and late adolescents’ well-being in Greece, Norway, Poland and Switzerland: Associations with individuation from parents. Journal of Child and Family Studies, 28(2), 560-576.
18. Germani, A., Delvecchio, E., Li, J., & Mazzeschi, C. (2020). The horizontal and vertical individualism and collectivism scale: Early evidence on validation in an Italian sample. Journal of Child and Family Studies, 29, 904-911.
19. Hamilton, J. L, Potter, C. M., Olino, T. M., Abramson, L.Y., Heimberg, R. G., & Alloy, L. B. (2016). The temporal sequence of social Anxiety and depressive symptoms following interpersonal stressors during adolescence. Journal of Abnormal Child Psychology, 44, 495-509.
20. Haslam, D., Poniman, C., Filus, A., Sumargi, A., & Boediman, L. (2020).Parenting style, child emotion regulation and behavioral problems: The moderating role of cultural values in Australia and Indonesia. Marriage and Family Review, 56(4), 320-342.
21. Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process: A regression based approach. New York: The Guilford Press.
22. Hopwood, C. J., & Good, E. W. (2019). Structure and correlates of interpersonal problems and sensitivities.Journal of personality,87(4), 843-855.
23. Huang, T., Liu, Y., & Yu P. (2016). The crucial influences of interpersonal relationships on learning motivation and performance in a cloud-based collaborative learning platform. Education Journal, 44(1), 133-157.
24. Jenkins, L. N., Demaray, M. K., Fredrick, S. S., & Summers, K. H. (2016). Associations among middle school students’ bullying roles and social skills. Journal of School Violence, 15(3), 259-278.
25. Jeon, S., & Neppl, T. K. (2019). Economic pressure, parent positivity, positive parenting, and child social competence. Journal of Child and Family Studies, 28(5), 1402-1412.
26. Jhang, F. (2017). Economically disadvantaged adolescents’ self-concept and academic achievement as mediators between family cohesion and mental health in Taiwan. International Journal of Mental Health Addiction, 15, 407-422.
27. Joybari, M. T. (2014). Depression and interpersonal problems in adolescents: Their relationship with alexithymia and coping styles. Iranian Journal of Psychiatry and Behavioral Sciences, 8(4), 38-45.
28. Keyho, K., Gujar, N. M., & Ali, A. (2019). Prevalence of mental health status in adolescent school children of Kohima District, Nagaland. Annals of Indian Psychiatry, 3, 39-42.
29. King, V., Boyd, L. M., & Pragg, B. (2017).Parent–adolescent closeness, family belonging, and adolescent well-being across family structures. Journal of Family Issues, 39(7), 2007-2036.<
30. Kumar, R. (2019). A comparative study of government and private school students on mental health and self-esteem. International Journal of Yogic, Human Movement and Sports Sciences, 4(1), 1149-1155.
31. Kumar, M., Bhilwar, M., Kapoor, R., Sharma, P., & Parija, P. (2016). Prevalence of aggression among school-going adolescents in India: A review study. Indian Journal of Youth and Adolescent Health, 3(4), 39-47.
32. Leidy, M. S., Guerra, N. G., & Toro, R. I. (2010). Positive parenting, family cohesion, and child social competence among immigrant Latino families. Journal of Family Psychology, 24(3), 252-260.
33. Ma, Y., Siu, A., & Tse, W. S. (2018).The role of high parental expectations in adolescents’ academic performance and depression in Hong Kong. Journal of Family Issues, 39(9), 2505-2522.
34. Masselink, M., Roekel, E. V., & Oldehinkel, A. J. (2018). Self-esteem in early adolescence as predictor of depressive symptoms in late adolescence and early adulthood: The mediating role of motivational and social factors. Journal of Youth and Adolescence, 47, 932-946.
35. McErlean, A. B. J., Lim, L. X. C. (2020). Relationship between parenting style, alexithymia and aggression in emerging adults. Journal of Family Issues, 41(6), 853-874.
36. McKinney, C., & Kwan, J. W. (2018).Emerging adult perceptions of and preferences for parenting styles and associated psychological outcomes. Journal of Family Issues, 39(9), 2491-2504.
37. McLaughlin, K. A., Rith-Najarian, L., Dirks, M. A., & Sheridan, M. A. (2015). Low vagal tone magnifies the association between psychosocial stress exposure and internalizing psychopathology in adolescents. Journal of Clinical Child and Adolescent Psychology, 44(2), 314-328.
38. Mestre, M. V., Carlo, G., Samper, P., Malonda, E., & Mestre, A. L. (2019). Bidirectional relations among empathy-related traits, prosocial moral reasoning, and prosocial behaviors. Social Development, 28(3), 514-528.
39. Mouton, B., Loop, L., Stievenart, M., & Roskam, I. (2018).Parenting programs to reduce Young children’s externalizing behavior: A meta-analytic review of their behavioral or cognitive orientation. Child and Family Behavior Therapy, 40(2), 115-147.
40. Muris, P., Meesters, C., & Van Brakel, A. (2003). Assessment of anxious rearing behaviors with a modified version of the ‘‘Egna Minnen Betra¨ ffende Uppfostran’’ (EMBU) questionnaire for children. Journal of Psychopathology and Behavioral Assessment, 25(4), 229-237.
41. Nadeem, A., Mahmood, Z., & Saleem, S. (2018). Personality traits as predictors of interpersonal difficulties in university students in Pakistan. Pakistan Journal of Social and Clinical Psychology, 16(1), 3-9.
42. Nair, S., Ganjiwale, J., Kharod, N., Varma, J., & Nimbalkar, S. M. (2017). Epidemiological survey of mental health in adolescent school children of Gujarat, India. BMJ Paediatrics Open, 1, 1-8.
43. Pinquart, M. (2016). Associations of parenting dimensions and styles with internalizing symptoms in children and adolescents: A meta-analysis. Marriage and Family Review, 53(7), 613-640.
44. Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual Research Review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345-365.
45. Razali, A. (2017). Personal and interpersonal factors with the inclination to relapse. Masyarakat, Kebudayaan Dan Politik, 30(3), 310-321.
46. Rohner, R. P. (1986). The warmth dimension: Foundations of parental acceptance-rejection theory. Beverly Hills, CA: Sage Publications, Inc.
47. Rohner, R. P. (2004). The parental acceptance-rejection syndrome: Universal correlates of perceived rejection. American Psychologist, 59, 830-840.
48. Ruiz, M. M. R., Carrasco, M. A., & Holgado-Tello, F. P. (2019). Father involvement and children’s psychological adjustment: maternal and paternal acceptance as mediators. Journal of Family Studies, 25(2), 151-169.
49. Salavera, C., Usan, P., & Jarie, L. (2018). Styles of humour and social skills in students: Gender differences. Current Psychology, 37(1), 1-10.
50. Saleem, S., Asghar, A, Subhan, S., & Mahmood, Z. (2019). Parental rejection and mental health problems in college students: Mediating role of interpersonal difficulties. Pakistan Journal of Psychological Research, 34(3), 639-653.
51. Saleem, S., Ihsan, Z., & Mahmood, Z. (2014). Development of interpersonal difficulty scale for university student. Pakistan Journal of Psychological Research, 29(2), 277-297.
52. Saleem, S., & Mahmood, Z. (2011). Development of a scale for assessing emotional and behavioral problems of school children. Pakistan Journal of Social and Clinical Psychology, 9, 73-78.
53. Saleem, S., Mahmood, Z., & Daud, S. (2017). Perceived parenting styles in Pakistani adolescents: A validation study. Pakistan Journal of Psychological Research, 32(2), 487-509.
54. Saleem, S., Mahmood, Z., & Subhan, S. (2015). Perceived parental practices and mental health problems: Cross-cultural validation of EMBU-C on Pakistani adolescents. FWU Journal of Social Sciences, 9(1), 44-52.
55. Selamu, L. G., & Singhe, M. S. (2018). Mental health distress and academic performance of medical students: A review. Journal of Psychology and Clinical Psychiatry, 9(6), 675-678.
56. Shim, S. Y., & Lim, S. A. (2019). Paternal self-efficacy, fathering, and children’s behavioral problems in Korea. Journal of Child and Family Studies, 28(3), 851-859.
57. Skinner, B. F. (1969). Contingencies of reinforcement. New York: Appleton-Century-Crofts.
58. Sutherland, P. L. (2018). The impact of mental health issues on academic achievement in high school students (Unpublished master dissertation). Department of Social Work, California State University, San Bernardino.
59. Triandis, H. C. (2001). Individualism and collectivism: Past, present, and future. In D. Matsumoto (Ed.). The handbook of culture and psychology (pp. 35-50). New York: Oxford University Press.
60. Vygotsky, L. S. (1978). Mind in society. Cambridge, MA: Harvard University Press.
61. Wagner, G., Zeiler, M., Waldherr, K., Philipp, J., Truttmann, S., Dur, W., Treasure, J. L., & Karwautz, A. F. K. (2017). Mental health problems in Austrian adolescents: A nationwide, two-stage epidemiological study applying DSM-5 criteria. European Child and Adolescent Psychiatry, 26, 1483-1499.
62. Wang, C., Do, K. A., Bao, L., Xia, Y. R., Wu, C., & Couch, L. (2018). Ecological influences on Chinese adolescents’ problem behaviors: A multilevel analysis. Journal of Family Issues, 39(9), 2545-2571.
63. Wong, D. F. K., Zhuang, X. Y., & Ng, T. K. (2019). Is parental control beneficial or harmful to the development of young children in Hong Kong? Journal of Child and Family Studies, 28(3), 831-838.
64. Yang, X., Jiang, X., Mo, P. K., Cai, Y., Ma, L., & Lau, J. T. (2020). Prevalence and interpersonal correlates of internet gaming disorders among Chinese adolescents. International Journal of Environmental Research and Public Health, 17(579), 1-12.
65. Yurasek, A. M., Brick, L., Nestor, B., Hernandez, L., Graves, H., & Spirito, A. (2019). The effects of parent, sibling and peer substance use on adolescent drinking behaviors. Journal of Child and Family Studies, 28(1), 73-83.
66. Zahra, S. T., & Saleem, S. (2020). Assessing interpersonal difficulties in adolescence: A validation study (Unpublished Manuscript). Institute of Clinical Psychology, University of Management and Technology, Lahore.
67. Zahra, S. T., & Saleem, S. (2021a). Family cohesion and self-confidence as protective factors of depression in adolescents: A mediation analysis. Journal of the Pakistan Medical Association, 71(2B), 677-680.
68. Zahra, S. T., & Saleem, S. (2021b). The development of a family cohesion scale: A preliminary validation. FWU Journal of Social Sciences, 15(1), 120-131.
69. Zahra, S. T., Saleem, S., Subhan, S., & Mahmood, Z. (2021). Interpersonal skills scale: Development and validation in urbanized sample of adolescents. Social Development, 30(1), 23-37.
70. Zubizarreta, A., Calvete, E., & Hankin, B. L. (2019). Punitive parenting style and psychological problems in childhood: The moderating role of warmth and temperament. Journal of Child and Family Studies, 28(1), 233-244.