Anxiety in women - a Swedish national three-generational cohort study

Effectiveness of an unguided modular online intervention for highly anxious parents in preventing anxiety in their children: a parallel group randomised controlled trial

Background

Children whose parents have anxiety problems are at increased risk of developing anxiety themselves. Parenting behaviors are a contributing factor to intergenerational transmission. Interventions which seek to limit anxiogenic parenting behaviors have shown potential in reducing anxiety in offspring but are not widely accessible. This prevention trial aimed to establish the effectiveness of an unguided modular online intervention for highly anxious parents in preventing anxiety in their children.

Methods

A parallel group, block-randomised controlled trial of unblinded participants in a 1:1 ratio was conducted to compare efficacy of the online course compared to a no-intervention control. The intervention comprised 8 modules, of approximately 20 min each, and participants progressed through the course at their own pace. The study was conducted entirely online with a self-referred UK-based community sample of parents (child 2-11 years) with substantial anxiety. The primary outcome measure was change in parent-reported child anxiety, as measured by the Spence Children's Anxiety Scale-Parent Report (SCAS-P) or Spence Pre-School Anxiety Scale-Parent Report (Preschool SCAS). Secondary outcomes were child internalising, externalising, and attentional symptoms (Pediatric Symptom Checklist), and parent anxiety (SCARED-Adult). Analyses using complete case analysis following intention to treat principles investigated intervention effects at 6 months (primary analysis) and additionally at 9 to 25-months' follow-up. Trial registration: ClinicalTrials.GovNCT04755933, https://clinicaltrials.gov/ct2/show/NCT04755933.

Findings

1811 participants (intervention = 900; control = 911; 92.7% (1677/1810) female; 85.3% (1535/1800) White-British; 66.8% (1201/1799) university educated). Participant retention (based on primary outcome completion) at T2 (6-months post consent) was 67.6% overall (n = 1224) and substantially lower in the intervention arm 57.3% ((516/900) control = 77.8% (708/910)). Child anxiety was lower in the intervention group compared to control at 6-month follow-up (adjusted effect size estimate -0.15 (95% CI: -0.23 to -0.08, p < 0.001). There was very strong evidence that those in the intervention arm had lowered child anxiety (standardised SCAS score) compared to the control arm, with an effect size (Cohen's d) of -0.16 (95% CI: -0.23 to -0.08, p < 0.001). The difference in standardised Spence Child Anxiety Scale score between the arms was -0.15 standard deviations. On the original scales for SCAS-P (0-114) and Preschool SCAS (0-112), this corresponds to a reduction of -2.38 (95% CI: -3.59 to -1.16) and -2.68 (95% CI: -4.05 to -1.31), respectively. No reported harms.

Interpretation

A clinically unsupported online intervention designed for parents with high levels of anxiety is effective in reducing anxiety and internalising symptoms in their children, and also anxiety in parents. Given the low resource intensity of this intervention, and the positive effects reported here, these findings suggest it has promise in limiting the intergenerational transmission of severe anxiety.

Funding

This work was supported by Kavli Trust (grant 38/19).

Generalised anxiety and panic symptoms in the German National Cohort (NAKO)

OBJECTIVES

Anxiety disorders (AD) are common in the general population, leading to high emotional distress and disability. The German National Cohort (NAKO) is a population-based mega-cohort study, examining participants in 16 German regions. The present study includes data of the first 101,667 participants and investigates the frequency and severity of generalised anxiety symptoms and panic attacks (PA).

METHODS

The Generalised Anxiety Disorder Symptoms Scale (GAD-7) and the first part of the Patient Health Questionnaire Panic Disorder (PHQ-PD) were filled out by NAKO participants (93,002). We examined the correlation of GAD-7 and PHQ-PD with demographic variables, stress (PHQ-Stress), depression (PHQ-9) and childhood trauma (CTS).

RESULTS

The total proportion of prior lifetime diagnoses of AD in the NAKO cohort reached 7.8%. Panic attacks were reported by 6.0% and possible/probable current GAD symptoms in 5.2% of the examined participants. Higher anxiety severity was associated with female sex, lower education level, German as a foreign language and younger age as well as high perceived stress and depression.

CONCLUSIONS

Clinically relevant GAD symptoms as well as panic attacks are frequent in the NAKO and are associated with sociodemographic factors, and high anxiety symptoms are accompanied by pronounced stress and depression levels.

Psychological health of mothers and siblings of children with autism spectrum disorders during COVID-19 pandemic: new evidence in Italian families

BACKGROUND AND AIM

Psychological challenges are well recognized in families with a child with Autism Spectrum Disorders (ASD). Instead, less is known about the effects of traumatic scenarios, such as COVID-19, on the psychological health of these families. The main aim of this research was to study the psychological health of both mothers and typically developing (TD) siblings of children with ASD during the COVID-19 pandemic. Second, we investigated the relationship between the mothers' psychological resources and their children psychological well-being.

METHODS

The sample included 52 mothers and their children: 15 with one child with ASD and at least one TD child (aged 4-14) (ASD-siblings group) and 37 with one or more TD child (aged 4-14) (TD control group). The data were collected through an online platform; four standardized questionnaires (GAD-7, BDI-II, CD-RISC 25 and CBCL) were administered.

RESULTS

The analyses revealed more internalizing and total behavioral symptoms in the siblings of children with ASD, compared to TD control group. Regarding the mothers, we did not find differences in depression and anxious symptoms between the two groups. However, the results reported a lower level of resilience in the mothers of children with ASD relative to mothers of TD children. Finally, the psychological well-being of the TD children was associated with the level of mothers' anxiety only in the ASD-siblings group.

CONCLUSIONS

Overall, our data show that the COVID-19 outbreak may had been particularly challenging for families of children with ASD, and highlight the importance of intensifying psychological support to families.

Depression, anxiety and quality of life of Afghan women living in urban areas under the Taliban government: a cross-sectional study

OBJECTIVES

According to the World Health Organization, depression is a common mental health illness that is characterised by a persistent feeling of sadness and loss of interest. The present study examined the association of two mental health variables (ie, depression, anxiety) with quality of life (QoL) and the sociodemographic characteristics of Afghan women living in urban areas under the rule of Taliban government in Afghanistan.

DESIGN

Cross-sectional study administered between 10 November 2021 to 25 December 2021 among women.

SETTING

Across major provinces of Afghanistan (Herat, Mazar-e-Sharif, Kabul and Samangan).

MEASUREMENTS

Data were collected using a pretested structured questionnaire. Data entry was carried out using Microsoft Excel 2016. And then exported to IBM SPSS V.26 for Microsoft Windows. Logistic regression models were used to examine the association of depression, anxiety with QoL and sociodemographic characteristics among women (N=438).

RESULTS

The prevalence of depression symptoms was 80.4%, and the prevalence of mild to extremely severe anxiety was 81.0%. Depression symptoms among Afghan women were associated with being older, having more children, lower education level, other individuals' bad behaviour, bad events experienced in the past month, and feeling physically ill. Multiple regression analysis indicated that low monthly household income (adjusted OR, AOR 2.260; 95% CI 1.179 to 4.331, p=0.014) poor physical domain of QoL (AOR 4.436; 95% CI 1.748 to 11.256, p=0.002) and poor psychological domain of QoL (AOR 23.499; 95% CI 7.737 to 71.369, p<0.001) were significantly associated with depression.

CONCLUSION

The prevalence of depression was high among women living under the government of the Taliban in Afghanistan. Considering the high prevalence of depression, anxiety and their impact on QoL and the overall quality of healthcare services, international health organisations should implement programmes for regular screening of depression and anxiety, and there should be psychological counselling services available for vulnerable women living under the government of the Taliban.

Genetic and environmental sources of familial resemblance in anxiety: a nuclear twin family design

BACKGROUND

A dominant feature of anxiety disorders is familial aggregation. However, the underlying mechanisms of between- and within-generational anxiety resemblance remain poorly understood. By disentangling the genetic v. environmental sources of familial resemblance in anxiety, we can help prevent within-family transmission of anxiety disorders. Therefore, data from both parents and twins are needed to obtain unbiased and detailed estimations of genetic and environmental sources of similarity between family members.

METHODS

We examined data from 991 families with same-sex twins. Trait anxiety in twins was assessed via self-report and parent report, while parental trait anxiety was assessed via self-report. We established a nuclear twin family model and estimated genetic and environmental variances using two survey waves.

RESULTS

The results suggested that additive genetic (A), dominant genetic (D), and non-shared environmental (E) influences significantly contributed to trait anxiety, whereas familial environmental influences (F) and passive gene-environment correlations (rGE) did not. Sibling environmental influences (S) were only found in self-report data, and increased when genetic influences decreased from Wave 1 to Wave 2.

CONCLUSIONS

Our study highlights the important role of broad heritability in intrafamilial trait anxiety similarity. Parent-child resemblance occurred primarily due to shared genetic makeup rather than direct environmental transmission. Sibling-specific environments, as the only source of shared environments, need further investigation. These findings have both theoretical and practical significance for anxiety disorders. Future research can expand our understanding by examining the gene-environment interplay and sex differences.

Clinical Measures of Allostatic Load in Children and Adolescents with Food Allergy, Depression, or Anxiety

PURPOSE

Sustained high stress exposure results in chronic activation of the stress response system, dysregulated stress responses, high allostatic load, and poor later-life health. Children and adolescents with chronic health conditions face stressors related to their condition in addition to those typical of childhood and adolescence, placing them at risk of high allostatic load. The purpose of this secondary analysis was to examine whether youth with chronic health conditions differ from controls on clinical measures of allostatic load.

DESIGN AND METHODS

A secondary analysis of two datasets, the electronic health record of a tertiary children's hospital and data from the Survey of the Health of Wisconsin, compared youth with chronic health conditions to controls on clinical measures of allostatic load. Additional analyses explored whether parental stress and mental health influenced these relationships.

RESULTS

Analyses identified differences in BMI, blood pressure, and waist circumference between youth with food allergy, anxiety, or depression, and controls. These relationships differed for males and females and for those with comorbid mental and physical conditions, and were influenced by parent stress and mental health.

CONCLUSIONS

Results support future studies exploring whether high stress in youth with chronic health conditions leads to increased allostatic load. Incorporating biomarkers as well as genetic and epigenetic factors will provide critical insights.

PRACTICE IMPLICATIONS

Youth with mental and physical CHCs may be at increased risk of high allostatic load, reflected in clinical measures of metabolism, and should have regular assessments of their metabolic health.

Systematic Review and Meta-analysis of Genetically Informed Research: Associations Between Parent Anxiety and Offspring Internalizing Problems

OBJECTIVE

Parent anxiety is associated with offspring internalizing problems (emotional problems related to anxiety and depression). This may reflect causal processes, whereby exposure to parent anxiety directly influences offspring internalizing (and/or vice versa). However, parent-offspring associations could also be attributable to their genetic relatedness. A systematic review and meta-analysis were conducted to investigate whether exposure to parent anxiety is associated with offspring internalizing after controlling for genetic relatedness.

METHOD

A literature search across 5 databases identified 429 unique records. Publications were retained if they used a quasi-experimental design in a general population sample to control for participant relatedness in associations between parent anxiety and offspring internalizing outcomes. Publications were excluded if they involved an experimental exposure or intervention. Studies of prenatal and postnatal anxiety exposure were meta-analyzed separately. Pearson's correlation coefficient estimates (r) were pooled using multilevel random-effects models.

RESULTS

Eight publications were retained. Data were drawn from 4 population cohorts, each unique to a quasi-experimental design: adoption, sibling-comparison, children-of-twins or in vitro fertilization. Cohorts were located in northern Europe or America. Families were predominantly of European ancestry. Three publications (Nfamilies >11,700; offspring age range, 0.5-10 years) showed no association between prenatal anxiety exposure and offspring internalizing outcomes after accounting for participant relatedness (r = .04; 95% CI: -.07, .14). Six publications (Nfamilies >12,700; offspring age range, 0.75-22 years) showed a small but significant association between concurrent symptoms in parents and offspring after accounting for participant relatedness (r = .13; 95% CI: .04, .21).

CONCLUSION

Initial literature, derived from homogeneous populations, suggests that prenatal anxiety exposure does not cause offspring internalizing outcomes. However, postnatal anxiety exposure may be causally associated with concurrent offspring internalizing via nongenetic pathways. Longitudinal stability, child-to-parent effects, and the role of moderators and methodological biases require attention.

Intergenerational transmission of anxiety in Chinese migrant families: The mediating role of parents' perceptions of coparenting

BACKGROUND

There is evidence that anxiety transmits across generations. However, little is known about the intergenerational transmission of anxiety in Chinese migrant families and the potential mediators of the intergenerational transmission. Therefore, this study investigated the intergenerational transmission of anxiety from both fathers and mothers to children in Chinese migrant families and the mediating role of both mothers' and fathers' perceptions of coparenting.

METHODS

Participants were 477 elementary school-age children and both their parents in Chinese migrant families. Mothers and fathers self-reported their anxiety and perceptions of coparenting. Children's anxiety was measured based on maternal report and paternal report. Structural equation modelling was used to evaluate the mediating role of both mothers' and fathers' perceptions of coparenting in the intergenerational transmission of anxiety.

RESULTS

Anxiety was transmitted across generations from both fathers and mothers to migrant children, and fathers' (but not mothers') perceptions of coparenting mediated the intergenerational transmission of anxiety from both fathers and mothers to migrant children.

LIMITATIONS

Causal conclusions cannot be drawn based on cross-sectional research design.

CONCLUSIONS

Coparenting seemed to play an important role in the intergenerational transmission of anxiety. Interventions preventing the intergenerational transmission of anxiety should designate relevant effort enhancing fathers' perceptions of coparenting by changing fathers' negative perceptions and evaluations of the coparenting relationship and increasing mothers' high-quality coparenting behavior.

Expression of Stress-Mediating Genes is Increased in Term Placentas of Women with Chronic Self-Perceived Anxiety and Depression

Anxiety, chronical stress, and depression during pregnancy are considered to affect the offspring, presumably through placental dysregulation. We have studied the term placentae of pregnancies clinically monitored with the Beck’s Anxiety Inventory (BAI) and Edinburgh Postnatal Depression Scale (EPDS). A cutoff threshold for BAI/EPDS of 10 classed patients into an Index group (>10, n = 23) and a Control group (<10, n = 23). Cortisol concentrations in hair (HCC) were periodically monitored throughout pregnancy and delivery. Expression differences of main glucocorticoid pathway genes, i.e., corticotropin-releasing hormone (CRH), 11β-hydroxysteroid dehydrogenase (HSD11B2), glucocorticoid receptor (NR3C1), as well as other key stress biomarkers (Arginine Vasopressin, AVP and O-GlcNAc transferase, OGT) were explored in medial placentae using real-time qPCR and Western blotting. Moreover, gene expression changes were considered for their association with HCC, offspring, gender, and birthweight. A significant dysregulation of gene expression for CRH, AVP, and HSD11B2 genes was seen in the Index group, compared to controls, while OGT and NR3C1 expression remained similar between groups. Placental gene expression of the stress-modulating enzyme 11β-hydroxysteroid dehydrogenase (HSD11B2) was related to both hair cortisol levels (Rho = 0.54; p < 0.01) and the sex of the newborn in pregnancies perceived as stressful (Index, p < 0.05). Gene expression of CRH correlated with both AVP (Rho = 0.79; p < 0.001) and HSD11B2 (Rho = 0.45; p < 0.03), and also between AVP with both HSD11B2 (Rho = 0.6; p < 0.005) and NR3C1 (Rho = 0.56; p < 0.03) in the Control group but not in the Index group; suggesting a possible loss of interaction in the mechanisms of action of these genes under stress circumstances during pregnancy.

Anxiety in the family: a genetically informed analysis of transactional associations between mother, father and child anxiety symptoms

BACKGROUND

Anxiety in parents is associated with anxiety in offspring, although little is known about the mechanisms underpinning these intergenerational associations. We conducted the first genetically sensitive study to simultaneously examine the effects of mother, father and child anxiety symptoms on each other over time.

METHOD

Adoptive parent and child symptoms were measured at child ages 6, 7 and 8 years from 305 families involved in the Early Growth and Development Study, using a prospective adoption design. Children were adopted at birth to nonrelatives, and composite data on internalising problems within birth families were used as a proxy measure of offspring inherited risk for anxiety. Structural equation models were fitted to the data to examine prospective associations between adoptive mother, father and child symptoms, whilst accounting for individuals' symptom stability over time.

RESULTS

Child anxiety symptoms at age 7 predicted adoptive mothers' anxiety symptoms at age 8. No mother-to-child or child-to-father effects were observed. These results were consistent in sensitivity analyses using only paternal offspring reports and using a second measure of child anxiety symptoms. Fathers' anxiety symptoms at child age 6 prospectively predicted child symptoms, but only when paternal offspring reports were included in the model. Composite data on birth family internalising problems were not associated with child anxiety symptoms.

CONCLUSIONS

Results show environmentally mediated associations between parent and child anxiety symptoms. Results support developmental theories suggesting that child anxiety symptoms can exert influence on caregivers, and mothers and fathers may play unique roles during the development of child symptoms. Further research is needed on the role of genetic transmission associated with anxiety symptoms in biologically related families. In the meantime, researchers and clinicians should strive to include fathers in assessments and consider the effects of child symptoms on caregivers.