Abstract
Objective: A possible relationship between high pregnancy stress and the child’s short duration of breastfeeding, and psychopathology have been reported in research. However, relationship of childhood psychopathology with various factors in pre and postnatal periods is under-researched in Turkish academic literature and the results are inconsistent. Besides, existing local studies have either focused on certain diagnostic groups or only used screening questionnaires in preschool age children. The aim of the present study was therefore, to examine the relationship of these factors with childhood internalizing-externalizing psychopathology in a clinical sample, where diagnoses were confirmed with semi-structured interviews and their dimensional examination was supported with a validated questionnaire.
Methods: Subjects, aged between 6 and 18 years, who had been assessed at the Bezmialem Vakıf University, Child and Adolescent Psychiatry Clinic between June and December 2016, were included to the study. A total of 100 children and adolescents diagnosed with an internalizing problem, 175 subjects with diagnosis of an externalizing problem and 59 children and adolescents with no diagnosis were examined. Diagnoses of the subjects were established with the Kiddie Schedule for Affective Disorders and Schizophrenia- Turkish Version (K-SADS-T) and psychiatric interview based on DSM-5 criteria for diagnoses not included in the K-SADS-T. Strengths and difficulties questionnaire (SDQ) and a socio-demographic data tool about pre and postnatal factors were completed by the parents.
Findings: Mean age of the sample was 9.6±3.0 years and 67.7% of the sample were male. Total duration of breastfeeding was significantly lower (Z=2.61 p=0.009) in subjects with an externalizing problem (12.3±8.4 months) than subjects with no diagnosis (15.7±9.0 months). Proportion of the subjects breastfed for less than 6 months were significantly higher in subjects with internalizing problems (23.0%) and externalizing problems (48.6%) than children with no diagnosis (10.2%) (?2=4.10 p=0.043; ?2=5.53 p=0.019, respectively). Frequency of postpartum depression did not differ between groups, however postpartum anxiety was significantly more common in subjects with an externalizing problems (25.4%) as compared to subjects with no diagnosis (12.3%) (?2=4.20 p=0.038).
Conclusion: According to our literature search, the present study is the first, where relationship between pre and postnatal factors and internalizing-externalizing dichotomy in school age children were assessed using a clinical interview and screening questionnaire. Maternal postpartum anxiety and short duration of breastfeeding was shown to be related with long term negative consequences in the present study, which is in line with the existing literature.

Key words: Psychopathology, child and adolescent, internalizing problems, externalizing problems, breastfeeding