Tuesday, March 28, 2023
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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.
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CME / ABIM MOC / CE Released: 8/26/2022
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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.
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 DisruptorAnxiety 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 EssentialReached 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.
