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CME / ABIM MOC / CE

Is Transmission of Anxiety From Parents to Children Sex-Specific?

  • Authors: News Author: Megan Brooks; CME Author: Laurie Barclay, MD
  • CME / ABIM MOC / CE Released: 8/26/2022
  • Valid for credit through: 8/26/2023
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

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    IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for pediatricians, psychiatrists, internists, physician assistants, nurses, nurse practitioners, public health and prevention officials, family medicine and primary care clinicians, and other members of the health care team for children with anxiety and their parents.

The goal of this activity is for learners to be better able to describe whether the transmission of anxiety from parents to children is sex specific, based on the association of parent and offspring sex with anxiety disorder transmission in a cross-sectional family study in Nova Scotia, Canada.

Upon completion of this activity, participants will:

  • Assess the association of parent and offspring sex with anxiety disorder transmission, based on a cross-sectional family study in Nova Scotia, Canada
  • Evaluate the clinical implications of the association of parent and offspring sex with anxiety disorder transmission, based on a cross-sectional family study in Nova Scotia, Canada
  • Outline implications for the healthcare team


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News Author

  • Megan Brooks

    Freelance writer, Medscape

    Disclosures

    Megan Brooks has no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

     

    Disclosures

    Laurie Barclay, MD, has the following relevant financial relationships:
    Formerly owned stocks in: AbbVie 

Editor/Nurse Planner

  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

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    Stephanie Corder, ND, RN, CHCP, has no relevant financial relationships.

Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance, Medscape, LLC

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    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.

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This activity has been peer reviewed and the reviewer has no relevant financial relationships.


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CME / ABIM MOC / CE

Is Transmission of Anxiety From Parents to Children Sex-Specific?

Authors: News Author: Megan Brooks; CME Author: Laurie Barclay, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 8/26/2022

Valid for credit through: 8/26/2023

processing....

Clinical Context

Anxiety disorders are highly prevalent psychiatric disorders, starting early in life and heralding later depression, bipolar disorder, educational underachievement, harmful substance use, and suicide. A parent with an anxiety disorder is one of the strongest known risk factors, and risk increases further with 2 affected parents.

As children share a similar number of autosomal genetic variants with each parent, patterns of sex-specific transmission of psychiatric disorders could indicate different underlying mechanisms. Stronger contribution of the opposite-sex parent to transmission suggests an X-chromosome-related disorder, whereas stronger contribution of the same-sex parent may reflect modeling.

Study Synopsis and Perspective

Transmission of anxiety appears to be sex-specific, spreading from mothers to daughters and from fathers to sons, new research shows.

The new findings suggest that children learn anxious behavior from their parents, study investigator Barbara Pavlova, PhD, clinical psychologist with Nova Scotia Health Authority, told Medscape Medical News.

"This means that transmission of anxiety from parents to children may be preventable," said Dr Pavlova, assistant professor, Department of Psychiatry, Dalhousie University, Halifax, Canada.

"Treating parents' anxiety is not just important for their own health but also for the health of their children. This may be especially true if the child and the parent are the same sex," Dr Pavlova added.

The study was published online July 12 in JAMA Network Open.[1]

Parental Anxiety a Disruptor

Anxiety disorders run in families. Both genes and environment are thought to be at play, but there are few data on sex-specific transmission from parent to child.

To investigate, the researchers conducted a cross-sectional study of 203 girls and 195 boys and their parents. The average age of the children was 11 years, and they had a familial risk for mood disorders.

Anxiety disorder in a same-sex parent was significantly associated with anxiety disorder in offspring (odds ratio [OR], 2.85; 95% confidence interval [CI], 1.52-5.34; P=.001), but not in an opposite-sex parent (OR, 1.51; 95% CI, 0.81-2.81; P=.20).

Living with a same-sex parent without anxiety was associated with lower rates of offspring anxiety (OR, 0.38; 95% CI, 0.22-0.67; P=.001).

Among all 398 children, 108 (27%) had been diagnosed with 1 or more anxiety disorders, including generalized anxiety disorder (7.8%), social anxiety disorder (6.3%), separation anxiety disorder (8.6%), specific phobia (8%), and anxiety disorder not otherwise specified (5%).

Rates of anxiety disorders in children increased with age, from 14% in those younger than 9 years to 52% in those older than 15 years. Anxiety disorders were similarly common among boys (24%) and girls (30%).

Rates of anxiety disorders were lowest (24%) in children of 2 parents without anxiety disorders and highest (41%) in cases in which both parents had anxiety disorders.

The findings point to the possible role of environmental factors, "such as modeling and vicarious learning, in the transmission of anxiety from parents to [their] children," the researchers note.

"A child receives similar amount of genetic information from each biological parent. A strong same-sex parent effect suggests children learn resilience by modeling the behavior of their same-sex parent. A parent's anxiety disorder may disrupt this protective learning," said Dr Pavlova.

Early Diagnosis, Treatment Essential

Reached for comment, Jill Emanuele, PhD, vice president of clinical training for the Child MIND Institute in New York City, said that when it comes to anxiety, it is important to assess and treat both the parent and the child.

"We know that both environment and genetics play a role in anxiety disorders. From a clinical perspective, if we see a parent with an anxiety disorder, we know that there is a chance that that is also going to affect the child, whether or not the child has an anxiety disorder," Dr Emanuele told Medscape Medical News.

"Anxiety disorders are the most common psychiatric disorders diagnosed. We also know that anxiety disorders emerge earlier than mood disorders, and certainly can emerge in childhood. It's important to address anxiety early because those same problems can continue into adulthood if left untreated," Dr Emanuele added.

The study was supported by the Canada Research Chairs Program, the Canadian Institutes of Health Research, the Brain & Behavior Research Foundation, the Nova Scotia Health Research Foundation, and the Dalhousie Medical Research Foundation. The authors have disclosed no relevant financial relationships. Dr Emanuele is a board member with the Anxiety and Depression Association of America.

JAMA Netw Open. Published online July 12, 2022.

Study Highlights

  • This cross-sectional family study in Nova Scotia, Canada, recruited participants from the general population (enriched for familial risk for mood disorders) from February 1, 2013, to January 31, 2020.
  • Participants included 398 offspring (203 girls [mean age, 11.1±3.7 years]; 195 boys [mean age, 10.6±3.1 years]), 221 mothers, and 237 fathers.
  • Semistructured interviews determined lifetime diagnoses of anxiety disorder in parents and offspring.
  • Anxiety disorders in the same-sex parent were associated with increased rates of anxiety disorders in the offspring (OR, 2.85; 95% CI, 1.52-5.34; P=.001), based on logistic regression, whereas anxiety disorders in the opposite-sex parent were not (OR, 1.51; 95% CI, 0.81-2.81; P=.20).
  • Sharing a household with a same-sex parent without anxiety was linked to lower rates of offspring anxiety (OR, 0.38; 95% CI, 0.22-0.67; P=.001), but the presence of an opposite-sex parent without anxiety was not (OR, 0.96; 0.56-1.63; P=.88).
  • Of the 398 offspring, 27% had at least 1 anxiety disorder, including generalized anxiety disorder (7.8%), social anxiety disorder (6.3%), separation anxiety disorder (8.6%), specific phobia (8%), and anxiety disorder not otherwise specified (5%).
  • Rates of anxiety disorders in children increased with age, from 14% at younger than 9 years to 52% at older than 15 years, and were similarly common among boys (24%) and girls (30%).
  • Rates of anxiety disorders in children were lowest (24%) when neither parent had anxiety disorders, intermediate with 1 affected parent (28%), and highest (41%) when both had anxiety disorders.
  • Odds of lifetime anxiety disorder diagnosis in offspring increased proportionately to the number of parents with anxiety disorders (OR, 2.22; 95% CI, 1.38-3.57; P=.001).
  • The investigators concluded that offspring with a same-sex parent with an anxiety disorder were more likely to have an anxiety disorder than offspring with an opposite-sex parent with an anxiety disorder, suggesting that intergenerational transmission of anxiety disorders is largely accounted for by same-sex parent transmission.
  • This association between the same-sex parent's anxiety disorder and anxiety disorders in offspring suggests an environmental mechanism, such as modeling and vicarious learning, in anxiety transmission from parents to children.
  • Same-sex transmission of anxiety disorders has no clear genetic explanation, but genetic contribution to anxiety is well documented.
  • The findings should not be interpreted as evidence against genetic effects, as environmental factors, including parenting, likely shape this disposition into an anxiety disorder or contribute to the child's resilience to anxiety.
  • Treating parents with anxiety disorders is therefore important, especially for same-sex offspring.
  • Treating anxiety in parents with and without mood disorders may protect the offspring against anxiety disorders, as intergenerational transmission of anxiety appears largely driven by the parent's anxiety rather than mood disorder.
  • Anxiety disorders are treatable in children and young people.
  • Cognitive behavioral therapies (CBT) are effective for reducing likelihood of anxiety onset and maintenance in young children with behavioral inhibition, a well-established risk factor for anxiety disorders.
  • Children with behavioral inhibition and a same-sex parent with anxiety disorder may have the greatest need for preventive interventions.
  • Study limitations include relatively low mean offspring age; inability to establish the association between parental psychiatric disorders and onset of mood disorders in children, or whether parental recovery from anxiety disorder reduces their children's risk of developing an anxiety disorder; lack of controlling for childhood adversity or socioeconomic status; and inability to exclude reverse causality, given the 2-way interaction between parental and child anxiety.
  • Future multigenerational studies should collect data on sex-specific transmission of anxiety disorders and examine whether treating parents' anxiety may protect their children, especially their same-sex offspring, from developing an anxiety disorder regardless of parental mood disorder.
  • Studies assessing preventive interventions for children of parents with anxiety should assess whether outcomes differ in same-sex and opposite-sex parent-child pairs.

Clinical Implications

  • Same-sex parent transmission largely accounts for intergenerational transmission of anxiety disorders.
  • This suggests an environmental mechanism, such as modeling and vicarious learning, in anxiety transmission from parents to children.
  • Implications for the Health Care Team: When managing patients with anxiety disorders, members of the healthcare team should collaborate across care environments to ensure that both the parent and the child are evaluated and treated, especially same-sex offspring.

 

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