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Anxiety disorders in mothers and their children: Prospective longitudinal community study

  • Andrea Schreier (a1), Hans-Ulrich Wittchen (a2), Michael Höfler (a3) and Roselind Lieb (a4)
Summary

The relationship between DSM-IV anxiety disorders and their clinical characteristics in mothers and anxiety in offspring was examined in 933 mother–child pairs from a longitudinal community study. Offspring of mothers with an anxiety disorder had an elevated risk of developing any anxiety disorder, compared with offspring of mothers with no anxiety disorder. Increased risk of anxiety in the offspring was especially associated with maternal social phobia and generalised anxiety disorder, and with maternal diagnoses of early onset, greater number and more severe impairment. These results suggest that the type of maternal anxiety disorder and its severity of manifestation contribute to mother-offspring aggregation of anxiety.

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Copyright
Corresponding author
Andrea Schreier, PhD, Max Planck Institute of Psychiatry, Kraepelinstr. 2, 80804 Munich, Germany. Email: schreier@mpipsykl.mpg.de
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Declaration of interest

None.

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References
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1 Schreier, A, Höfler, M, Wittchen, HU, Lieb, R. Clinical characteristics of major depressive disorder run in families – a community study of 933 mothers and their children. J Psychiatr Res 2006; 40: 283–92.
2 Merikangas, KR. Vulnerability factors for anxiety disorders in children and adolescents. Child Adolesc Psychiatr Clin N Am 2005; 14: 649–79.
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4 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). APA, 1994.
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6 Wittchen, HU, Perkonigg, A, Lachner, G, Nelson, CB. Early Developmental Stages of Psychopathology Study (EDSP): objectives and design. Eur Addict Res 1998; 4: 1827.
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8 McCullagh, P, Nelder, JA. Generalized Linear Models (2nd edn). Chapman & Hall, 1989.
9 Lieb, R, Isensee, B, Höfler, M, Pfister, H, Wittchen, HU. Parental major depression and the risk of depressive and other mental disorders in offspring: a prospective-longitudinal community study. Arch Gen Psychiatry 2002; 59: 365–74.
10 Beidel, DC, Turner, SM. At risk for anxiety: I. Psychopathology in the offspring of anxious parents. J Am Acad Child Adolesc Psychiatry 1997; 36: 918–24.
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Anxiety disorders in mothers and their children: Prospective longitudinal community study

  • Andrea Schreier (a1), Hans-Ulrich Wittchen (a2), Michael Höfler (a3) and Roselind Lieb (a4)
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Andrea Schreier
17 April 2008

As Mushtaq and Minn-Din point out quite correctly in their eletter referring to our paper Schreier et al1, Bijl et al2 did not find associations between prevalence rates of any psychiatric disorder (including anxiety disorders) in children and anxiety-related symptoms in parents. However, one must be aware of several methodological differences to our investigation: the results cited by Mushtaq and Minn-Din are based on 12-months prevalence rates and multivariate logistic regression analysis additionally controlling for childhood adversities and sociodemographic characteristics. We would like to clarify, that the results of the Bijl et al paper that are much more comparable to our studyand that we are actually referring to are those based on life-time prevalence rates of psychiatric disorders in children without controlling for childhood adversities and reported separately for the various offspring disorders. Here Bijl et al clearly report associations between anxiety in parents and children.

In addition, it is true that the adult children in the Bijl et al study were considerably older (18-65 years) than the offspring in the Schreier et al study (17-21 years at follow-up). We would like to add, that there are other substantial ways in which the studies differ, e.g. assessment via direct interviews1 versus family-history information.2 Nevertheless, we do not see why our claim that we confirm and extend the Bijl et al study should be problematic, especially when taking into account the low median for age at onset of anxiety disorders.3

We would also like to point out that both the Bijl et al and Schreieret al studies are community-based so that the use of the term “patients” by Mushtaq and Minn-Din is slightly misleading.

1. Schreier A, Wittchen HU, Höfler M, Lieb R. Anxiety disorders in mothers and their children: prospective longitudinal community study. Br JPsychiatry 2008; 192:308-309.

2. Bijl RV, Cuijpers P, Smit F. Psychiatric disorders in adult children of parents with a history of psychopathology. Soc Psychiatry Psychiatr Epidemiol 2002; 37:7-12.

3. Andrade L, Caraveo-Anduage JJ, Berglund P, et al. Cross-national comparisons of the prevalences and correlates of mental disorders. Bull World Health Organ 2000; 78:413-426

Andrea Schreier, Hans-Ulrich Wittchen, Michael Höfler, Roselind Lieb

Declaration of Interest: None
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Conflict of interest: None Declared

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Anxiety Disorders in mothers and their children

Imran Mushtaq, Associate Specialist-Child & Adolescent Psychiatrist
09 April 2008

The study of Schreier et al1 is interesting as they have found that the risk of anxiety disorders in children is increased when mothers have specific anxiety disorders such as social phobia and generalized anxiety disorder. They also claim that their findings confirm and extend the previous findings of Bijl et al2. However, Bijl et al did not demonstratethat parental anxiety symptoms were significantly related to psychiatric disorders in the children, including anxiety disorders. In addition, anxiety disorders in the children were not related to most parental psychiatric symptoms. Moreover their patients were older (adult children) than those in Schreier et al study and we are not certain whether it is possible to compare these two different study populations.

References

1. Schreier A, Wittchen HU, Höfler M, and Lieb R. Anxiety disorders in mothers and their children: prospective longitudinal community study. British Journal of Psychiatry 2008;192:308-309.

2. Bijl RV, Cuijpers P, Smit F. Psychiatric disorders in adult children of parents with a history of psychopathology. Soc Psychiatry Psychiatr Epidemiol, 2002 ; 37:7-12.

Authors:

Imran Mushtaq Associate Specialist-Child & Adolescent Psychiatrist Specialist-CAHMS, Eaglestone Centre, Standing Way,Molton Keynes MK6 5AZ

Marla Minn-Din Acting Consultant Child and Adolescent PsychiatristChild, Adolescent and Family Services, 8 Notre Dame MewsNorthampton NN1 2BG

Declaration of Interest: None
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Conflict of interest: None Declared

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