Research report
Affective disorder in the parents of a clinic sample of children with anxiety disorders

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Abstract

Background

Family history studies in adults reveal strong familiality for the anxiety disorders with some specificity. The aim of the current study was to establish whether there was an elevated rate of anxiety disorders in the parents of children with anxiety disorders, and whether there was intergenerational specificity in the form of disorder.

Methods

The mental state of a clinic sample of 85 children with anxiety disorder and their parents was systematically assessed, together with a comparison sample of 45 children with no current disorder and their parents.

Results

Compared to the rate of anxiety disorder amongst parents of comparison children, the rate of current anxiety disorder in mothers of anxious children was significantly raised, as was the lifetime rate of anxiety disorder for both mothers and fathers. The mothers of children with generalised anxiety disorder, social phobia, specific phobia and separation anxiety disorder all had raised lifetime rates of the corresponding disorder, but also raised rates of others disorders.

Limitations

Only 60% of the fathers of the anxious children were assessed.

Conclusions

Strong familiality of anxiety disorders was confirmed, especially between child and maternal anxiety disorder. All child anxiety disorders were associated with several forms of anxiety disorder in the mother. Some specificity in the form of anxiety disorder in the child and the mother was apparent for social phobia and separation anxiety disorder. The findings have implications for the management of child anxiety.

Introduction

There is strong evidence that anxiety disorders are familial (Maier et al., 1993, Mendlewicz et al., 1993, Fyer et al., 1995, Stein et al., 1998), and some evidence of specificity in this aggregation (Fyer et al., 1995, Hettema et al., 2001). The rate of anxiety disorders amongst the children of anxious parents has also been found to be raised (Beidel and Turner, 1997, Turner et al., 1987, Merikangas et al., 1998, Biederman et al., 1991), as has the rate of disorder amongst the parents of shy and of behaviourally inhibited children (Rosenbaum et al., 1991, Cooper and Eke, 1999).

Two controlled studies have examined the rate of anxiety disorder and other psychiatric disorders in the relatives of a clinic sample of anxious children. Last et al. (1987) assessed the psychiatric histories of mothers of children with DSM-III separation anxiety disorder and/or overanxious disorder, and compared them with those of mothers of children with no anxiety or affective disorder. The current and lifetime rate of anxiety disorder amongst the mothers of the anxious children was more than double that of the mothers of control children. In a second study, Last et al. (1991) found the lifetime rate of anxiety disorder in relatives of children with anxiety disorders, children with ADHD and normal control children to be 40.4%, 28.3% and 18.5%, respectively; much of the difference between the groups are attributed to differential rates amongst index and control male relatives.

Two important issues arising from the seminal studies by Last and colleagues require further examination. First, as Last et al. (1991) note, the question whether the rates of anxiety disorder are elevated in both the mothers and the fathers of children with anxiety disorders needs clarification. In contrast to Last et al. (1991), McClure et al. (2001), in a community study, found a substantially raised rate of anxiety disorders in the mothers, but not fathers, of anxious adolescents. Second, the extent to which there is intergenerational specificity in the anxiety disorders remains uncertain.

In the current study we addressed these questions by establishing the current and lifetime rates of anxiety disorder, mood disorder, and substance abuse in the parents of a sample of children referred to a specialist clinic for treatment of an anxiety disorder and the parents of a sample of control children with no current anxiety disorder.

Section snippets

Method

The study index group was derived from a consecutive series of 98 children, between the ages of 6 and 16 years, referred to a specialist child anxiety disorder clinic. The mental state of these children was systematically assessed. Six were found not to have a DSM-IV anxiety disorder, and a further seven were excluded (significant learning problem, autistic spectrum disorder). The remaining 85 children were assessed using the ADIS for DSM-IV:C/P (Silverman and Albano, 1996). At the same time a

Results

The index and control children were similarly aged (mean = 125.1 months, S.D. = 29.5 months, and mean = 123.0 months, S.D. = 28.5 months, respectively). 44 (51.8%) of the anxious children were girls, as were 21 (46.7%) of the controls. The ages of the mothers were similar for the two samples (t = 0.08), as were the fathers' (t = 0.28). The social class distribution of the two groups was also similar (χ2 = 1.53, df = 1). In the families of the anxious children, a significantly smaller proportion of the parents

Discussion

Like Last et al. (1991), we found child anxiety disorder to be strongly associated with anxiety disorder in the parents. However, in contrast to Last et al. (1991), in our sample the association was stronger between mother and child than between father and child. Our findings are in line with those from the community study of McClure et al. (2001), as well as with a meta-analysis that indicated a stronger association between child internalising problems and maternal psychopathology than

Acknowledgements

The research was supported by the NHS Executive and the Economic and Social Research Council of Great Britain. We are grateful to the children and their families who helped us with this study.

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