Transcript Anxiety, Mood, and Substance Use Disorders in Parents of Children

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Generalized Anxiety Disorder (GAD)
Obsessive-Compulsive Disorder (OCD)
Panic Disorder
Post-Traumatic Stress Disorder (PTSD)
Social Phobia (or Social Anxiety Disorder)
Characterized by chronic anxiety,
exaggerated worry and tension, even
when there is little or nothing to provoke
it
 Can't seem to shake their concerns
 Worries are accompanied by physical
symptoms, especially fatigue,
headaches, muscle tension, muscle
aches, difficulty swallowing, trembling,
twitching, irritability, sweating, and hot
flashes
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Diagnosed when a person worries excessively
about a variety of everyday problems for at least 6
months
GAD affects about 6.8 million American adults,
including twice as many women as men.
The disorder develops gradually and can begin at
any point in the life cycle, although the years of
highest risk are between childhood and middle
age.
There is evidence that genes play a modest role in
GAD.
Other anxiety disorders, depression, or substance
abuse often accompany GAD, which rarely occurs
alone.
Characterized by recurrent, unwanted
thoughts (obsessions) and/or repetitive
behaviors (compulsions).
 Repetitive behaviors such as
handwashing, counting, checking, or
cleaning are often performed with the
hope of preventing obsessive thoughts or
making them go away.
 Performing these "rituals" only temporary
relief, and not performing them increases
anxiety.
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OCD affects about 2.2 million American
adults and can be accompanied by
eating disorders, other anxiety disorders,
or depression.
 It strikes men and women in roughly
equal numbers and usually appears in
childhood, adolescence, or early
adulthood. One-third of adults with OCD
develop symptoms as children, and may
run in families.
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Panic disorder is an anxiety disorder and
is characterized by unexpected and
repeated episodes of intense fear
accompanied by physical symptoms
that may include chest pain, heart
palpitations, shortness of breath,
dizziness, or abdominal distress.
 Feelings of terror that strike suddenly and
repeatedly with no warning.
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During a panic attack, most likely your heart
will pound and you may feel sweaty, weak,
faint, or dizzy. Your hands may tingle or feel
numb, and you might feel flushed or chilled.
You may have nausea, chest pain or
smothering sensations, a sense of unreality,
or fear of impending doom or loss of
control.
 Often accompanied by other serious
problems, such as depression, drug abuse,
or alcoholism.
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Can develop after exposure to a terrifying
event or ordeal in which grave physical harm
occurred or was threatened. Traumatic events
that may trigger PTSD include violent personal
assaults, natural or human-caused disasters,
accidents, or military combat.
People with PTSD have persistent frightening
thoughts and memories of their ordeal and feel
emotionally numb, especially with people they
were once close to. They may experience
sleep problems, feel detached or numb, or be
easily startled.
Anyone can get PTSD at any age. This
includes war veterans and survivors of
physical and sexual assault, abuse,
accidents, disasters, and many other
serious events.
 Some people get PTSD after a friend or
family member experiences danger or is
harmed. The sudden, unexpected death
of a loved one can also cause PTSD.
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Characterized by overwhelming anxiety and
excessive self-consciousness in everyday social
situations. Social phobia can be limited to only one
type of situation, such as a fear of speaking in
formal or informal situations, or eating or drinking in
front of others or, in its most severe form, may be so
broad that a person experiences symptoms almost
anytime they are around other people.
People with social phobia have a persistent,
intense, and chronic fear of being watched and
judged by others and being embarrassed or
humiliated by their own actions. Their fear may be
so severe that it interferes with work or school, and
other ordinary activities.
Physical symptoms often accompany the intense
anxiety of social phobia and include blushing,
profuse sweating, trembling, nausea, and difficulty
talking.
 Social phobia affects about 15 million American
adults.
 Women and men are equally likely to develop the
disorder.
 Usually begins in childhood or early adolescence.
 There is some evidence that genetic factors are
involved.
 Often accompanied by other anxiety disorders or
depression, and substance abuse may develop if
people try to self-medicate their anxiety.
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This term encompasses both
dependence on and abuse of drugs
usually taken voluntarily for the purpose
of their effect on the central nervous
system (usually referred to as intoxication
or "high") or to prevent or reduce
withdrawal symptoms.
 These mental disorders form a
subcategory of the substance-related
disorders.
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Trait
Anxiety
Depression
Withdrawal
Somatic
complaints
State
 Attention problems
 Aggressive
behavior
 Rule-breaking
actions
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Children of depressed mothers had
significantly higher rates of lifetime
depressive, separation anxiety,
oppositional defiant, and any psychiatric
disorders
 Children of depressed mothers also
reported significantly lower psychosocial
functioning and had higher rates of
psychiatric treatment
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Association between lower socioeconomic
status and higher rates of psychiatric
disorders (including MDD)
 Higher prevalence of lifetime MDD in
families with yearly incomes below $10,000
and in poor mothers with low income
 Results indicate a significant relationship
between maternal depression and
behavioral and emotional problems in the
children
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Higher prevalence of depressive,
anxiety, and disruptive behavior
disorders as well as lower psychosocial
functioning in children of mothers with
lifetime depression compared to children
of never depressed mothers
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Predominately Hispanic immigrants from the
Caribbean Islands and Central America and
speak primarily Spanish
2 bilingual trained clinical interviewers
administered the Structured Clinical Interview
for the DSM-IV
Depressed mothers who had at least one
lifetime episode of DSM-IV MDD of at least 4
weeks in duration
Never depressed mothers with no lifetime
history of MDD
Up to 3 children per family 8-17 years old
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58 children
› 26 children of 16 depressed mothers
› 32 children of 19 never-depressed mothers
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Mothers were administered the clinical
interviews in Spanish and children in
English
Significantly higher lifetime prevalence of depressive
disorders, separation anxiety disorder, oppositional defiant
disorder, any psychiatric disorder, and suicidal ideation
compared to children of never depressed mothers
 Lower psychosocial functioning across several areas,
including lower general competence, overall home
functioning, more problems with peers and parents, and
lower quality relationships with their mother and siblings
 These findings in low-income minority population parallel
the findings in studies of children from more affluent
Caucasian populations
 Children of depressed parents social and school problems
are not due to lower scores on intelligence measures,
however other studies have reported lower scores on
intelligence measures and academic performance
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Results indicate that the overall lifetime prevalence
of psychiatric disorders in children of low-income
depressed mothers
Combination of socioeconomic factors and
maternal depression might place children at
particularly high risk for emotional and behavioral
problems
Poor people are less likely to seek mental health
treatment, less likely to receive treatment from
mental health specialists, and more likely to rely on
primary-care physicians for their mental health
needs
Studies have reported that treatment of maternal
depression can improve outcomes in children
including symptoms and function
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Samle size
Recruited a sample of convience - may
not be representative
Information on 6 children was obtained
solely from the mothers
Only on low-income families so doesn’t
allow for direct comparison across
socioeconomic groups
Risk for psychiatric disorders may be
particularly high in children of lowincome depressed mothers
 Multiple risk factors often coalesce in
poor children and early detection and
intervention become especially
important
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Examined prevalence of anxiety, mood,
and SUD in parents of children with
anxiety disorders and with no
psychological disorders.
 Investigated the relationship between
parent and child anxiety disorders.
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Anxiety disorders aggregate in families
Concordance between child and parent
anxiety is thought to result from a combination
of genetics, environment, and parenting
(including discouragement of social
interaction, modeling of cautious or fearful
responses, increased levels of parental control
and emotional involvement, and less granting
of autonomy)
Parents with anxiety disorders may model or
communicate through anxious self-talk their
specific anxieties to their children and place
them at greater risk for anxiety disorders
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Family members have a greatest influence on
one another when offspring are in childhood or
adolescence it seems likely that children and
their parents would exhibit levels of diagnostic
specificity similar to adult first-degree relatives
Parent-child association for OCD and a
significant mother-child but not father-child
association for SP
Theory that PD is a the adult manifestation of
SAD
A relationship between child SAD and
maternal lifetime SAD has been documented
Twin pair study support relationship
between maternal depression in the first
5 years of the twins lives and behavioral
problems displayed at 7 years of age in
a dose-response relationship
 Relationship between anxiety and
depressive disorders in children and
parent substance use problems may be
accounted for by a positive history of
anxiety or depressive disorders in parents
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Small samples
Lack of blind evaluators and/or
structured interviewers which may
influence diagnoses
No or low father participation
Findings that predate changes to
childhood anxiety disorders in the DSMIV
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Lifetime rates of anxiety, mood, and SUD in
mothers and fathers of AD (anxiety disordered)
children compared to mothers and fathers of
NPD (no psychological disorder)
Relationship between specific anxiety disorders
in children and their mothers and fathers in AD
children
Predicted that mothers and fathers of AD
children would exhibit greater lifetime rates of
anxiety, mood, and SUD as well as anxious and
depressive self-talk and self-reported symptoms
than mothers and fathers of NPD children
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Parents of AD children would
demonstrate similar diagnostic pattern of
anxiety diagnoses as their AD children
(ex children with social phobia would
have parents with social phobia, mothers
of panic disorder would have children
with SAD)
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230 children total presenting to the Child
and Adolescent Anxiety Disorders Clinic
(CAADC) and their parents
178 AD; 52 NPD
Children had an IQ > 80
English speaking
Not taking any anti-anxiety or anti-depressant
medication
› All participants were administered the anxiety
disorders interview schedule-parent and child
versions for DSM-IV to asses for child diagnoses
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NPD (No Psychological
Disorder) Children
AD (Anxiety Disordered)
Children
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178 children total
7-14 years old
53.4% males
85.8% Caucasian
14.2% Ethnic minority
57% diagnosed with more
than 1 anxiety disorder
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12% mood disorder
23% ADHD
7% ODD
6% selective mutism
4% functional enuresis
Percentage of children
meeting criteria for specific
child anxiety disorder and
mood disorder diagnoses
(Table 1)
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52 children total
8-14 years old
From same communities as AD
youth, responded to notices
for families to participate in
research
Did not met criteria for any
disorder
48.1% males
76.9% Caucasian
17.3% African-American
5.7% ethnic minority
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165 mothers
23-67 years old
87.1% Caucasian
12.9% ethnic minority
15% some graduate
school training
31.2% college graduates
25.3% some college
training
25.3% high school
graduates or (GED)
2.4% less than a high
school education
73.5% employed
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157 fathers
26-63 years old
87.1% Caucasian
12.9% ethnic minority
23% some graduate
school training
23.8% college graduates
20.0% some college
training
29.4% high school
graduates or (GED)
4.3% less than a high
school education
93.8% employed
4.2% below $20,000
 11.5% between $20,000-$40,000
 23.0% between $40,000-$60,000
 25.5% between $60,000-$80,000
 35.8% above $80,000
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52 mothers
28-52 years old
80.4% Caucasian
17.6% African-American
5.7% ethnic minority
20.0% some graduate
school training
40.0% college graduates
30.0% some college
training
10.0% high school
graduates or (GED)
82.0% employed
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50 fathers
33-56 years old
75.5% Caucasian
22.4% African-American
2.0% Hispanic
14.0% some graduate
school training
30.6% college graduates
30.6% some college
training
20.4% high school
graduates or (GED)
4.0% less than a high school
education
95.9% employed
4.2% below $20,000
 14.6% between $20,000-$40,000
 25.0% between $40,000-$60,000
 35.4% between $60,000-$80,000
 20.8% above $80,000
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AD (Anxiety
Disordered)
78.7% married
7.7% divorced
5.3% separated
7.1% never married
1.2% widowed
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NPD (No
Psychological
Disorder)
78.0% married
6.0% divorced
4.0% separated
12.0% never married
Anxiety disorders interview schedule-parent
and child versions for the DSM-IV (parent
(ADIS-P) and child version (ADIS-C))
 Semi-structured diagnostic interviews
administered to parents and children
independently to assess for DSM-IV anxiety
disorders
 ADIS-C – assessed symptomatology and
severity of anxiety, mood, and externalizing
disorders in youth
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Anxiety Disorders Interview Schedule-IV Lifetime
Version (ADIS-IV-L)
› assesses for the lifetime presence of DSM-IV disorders in
adults
› Administered by interviewer blind to reason for interview
› Diagnoses coded as absent or present, included: PD with
or without agoraphobia, SP, GAD, OCD, specific phobias,
mood disorders (MDD, dysthymia, and bipolar disorder),
and
SUD
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Anxious self-statements questionnaire (ASSQ)
› 32 item self-report measure that assesses the frequency of
self-talk associated with anxiety
› 1-5 pt scale
› Distinguishes between depressive and anxious self-talk
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Automatic Thoughts Questionanaire (ATQ-R)
› 40 item adult self-report questionnaire
› 30 negative self-statements and 10 positive self-
statements
› Rated on 1-5 pt scale to indicate the frequency of
thought in the last 2 months
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Beck Depression Inventory, Second Ed (BDI-II)
› 21 self-report measure of depressive symptoms
› Rated on a 0-4 pt scale
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State-Trait Anxiety Inventory (STAI)
› 20-item measure used to assess state (STAI-S) and
trait (STAI-T)
If child met initial criteria and parents
agreed then the children and parents were
scheduled for a diagnostic evaluation
 If child met criteria for an anxiety disorder
then parents were scheduled for a second
assessment to complete diagnostic
interviews
 Separate diagnosticians blind to child
diagnoses and reason for evaluation
administered the ADIS-IV-L to each parent
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Diagnosticians completed and passed a
2-phase training process before
conducting interviews
 Required to met 85% agreement with
experienced diagnosticians
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MANOVA conducted to examine
variance between AD and NPD youth on
parental self-reports of anxiety,
depression, and anxious and depressive
self-talk
 Significant difference with mothers of AD
youth reporting higher levels of trait and
state anxiety compared to mothers of
NPD
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Fathers of AD youth compared to fathers
of NPD youth showed significant group
differences in state anxiety but not trait
anxiety
 Both mothers and fathers of AD youth
reported more depressive symptoms
than mothers and fathers of NPD youth
 Mothers, not fathers, of AD youth
reported more anxious and depressive
self-talk than mothers of NPD youth
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Odds of any paternal lifetime anxiety
disorder were 2.33x higher in AD compared
to NPD youth
 No significant associations between lifetime
paternal SP with or without agoraphobia,
GAD, OCD, or specific phobias
 Significant association between AD youth
and lifetime SUD, odds of paternal SUD
were 2.52x higher in AD relative to NPD
youth
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Combined SAD and PD as one group,
significant association between child SAD/PD
and maternal lifetime PD
Maternal lifetime PD was 2.53x higher in youth
with SAD/PD
Maternal lifetime SP was 2.09x higher in youth
with SP relative to youth without
Odds of having OCD was 7.61x higher in
mothers of youth with OCD compared to those
without
Odds of a lifetime diagnosis of a specific
phobia was 2.55x higher in mothers of youth
with the diagnosis compared to those without
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Anxiety disorders aggregate in families
Increased rates of anxiety disorders were found
in the parents of AD youth compared to
parents of NPD
Mothers of AD youth were over 3x as likely to
meet criteria for SP in particular compared to
mothers of NPD youth
Fathers of AD youth were over 2x as likely to
meet criteria for any anxiety disorder
Associations between mother and child
psychopathology may be stronger than those
between father and child
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Parental modeling of catastrophic thinking and
anxious avoidance are related to the etiology
and maintenance of anxiety disorders in youth
In this study maternal modeling may contribute
to the similarity between mother and child
anxiety diagnoses
Presence of an AD child may be a stressor for
parents and may affect parents mental health
Women may be more likely than men to
experience psychological distress in response
to familial stress
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Fathers of AD youth had increased risk for lifetime SUD
Parents of AD youth were not found to be at
increased risk for a lifetime mood disorder, however
both reported higher levels of depressive
symptomatology and mothers of AD youth reported
more frequent depressive self-talk compared to NPD
parents
Rates of parental mood disorders were high in both
AD and NPD especially mothers (32% AD and 27%
NPD met the criteria for lifetime mood disorder)
Many AD youth met the criteria for multiple anxiety
disorders or comorbid mood and externalizing
disorders
Sample was predominantly Caucasian
families with children between the ages
of 7-14 and it is unclear whether these
findings will generalize to other ethnicities
or older children
 High levels of parental anxiety may be
associated with poorer treatment
response
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Anxiety disorders aggregate in families
and place individuals at greater risk for
developing mood and SUD
 Similarity in the diagnoses of AD children
and their mothers but not fathers suggest
the psychopathology between mother
and child may be stronger than father
and child
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Increased rates of anxiety disorders in
parents of youth with anxiety disorders
compared to parents of non-disordered
youth
› Child-mother relationship between SAD, PD, SP,
OCD, and specific phobias
› Child-father- fathers of AD children had an
increased risk for lifetime SUD and when the
presence of a paternal lifetime anxiety disorder
was controlled the association disappeared
suggesting the SUD was secondary to increased
rates of paternal anxiety
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905,000 children were abused or neglected in
2006 in the US.
› 64.2% were neglected.
› 16% were physically abused.
› 8.8% were sexually abused.
› 6.6% were emotionally or psychologically mistreated.
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High rates of major depression, PTSD, and other
behavioral disorders have been reported in
maltreated children and these disorders are
frequent in adults with a history of childhood
abuse.
According to the National Center of Child Abuse and Neglect
C. Heim and C. B. Nemeroff. The role of childhood trauma in the neurobiology of mood and anxiety
disorders: preclinical and clinical studies. Biol.Psychiatry 49 (12):1023-1039, 2001.