Review
Systematic Review and Meta-Analysis: Anxiety and Depressive Disorders in Offspring of Parents With Anxiety Disorders

https://doi.org/10.1016/j.jaac.2018.07.898Get rights and content
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Objective

We conducted meta-analyses to assess risk for anxiety disorders among offspring of parents with anxiety disorders, and to establish whether there is evidence of specificity of risk for anxiety disorders as opposed to depression in offspring, and whether particular parent anxiety disorders confer risks for particular child anxiety disorders. We also examined whether risk was moderated by offspring age, gender, temperament, and the presence of depressive disorders in parents.

Method

We searched PsycINFO, PubMed, and Web of Science in June, 2016, and July, 2017 (PROSPERO CRD42016048814). Study inclusion criteria were as follows: published in peer-reviewed journals; contained at least one group of parents with anxiety disorders and at least one comparison group of parents who did not have anxiety disorders; reported rates of anxiety disorders in offspring; and used validated diagnostic tools to ascertain diagnoses. We used random and mixed-effects models and evaluated study quality.

Results

We included 25 studies (7,285 offspring). Where parents had an anxiety disorder, offspring were significantly more likely to have anxiety (risk ratio [RR] = 1.76, 95% CI = 1.58−1.96) and depressive disorders (RR = 1.31, 95% CI = 1.13−1.52) than offspring of parents without anxiety disorders. Parent panic disorder and generalized anxiety disorder appeared to confer particular risk. Risk was greater for offspring anxiety than for depressive disorders (RR = 2.50, 95% CI = 1.50−4.16), and specifically for offspring generalized anxiety disorder, separation anxiety disorder and specific phobia, but there was no evidence that children of parents with particular anxiety disorders were at increased risk for the same particular anxiety disorders. Moderation analyses were possible only for offspring age, sex, and parental depressive disorder; none were significant.

Conclusion

Parent anxiety disorders pose specific risks of anxiety disorders to offspring. However, there is limited support for transmission of the same particular anxiety disorder. These results support the potential for targeted prevention of anxiety disorders.

Key words

anxiety disorders
depression
risk factors

Cited by (0)

Drs. Lawrence and Creswell are supported by a National Institute for Health Research (NIHR) Research Professorship to Dr. Creswell (NIHR-RP 2014-04-018).

The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health. The NIHR had no involvement in any aspect of this paper.

Dr. Murayama served as the statistical expert for this research.

The authors thank Chloe Williams, BSc, Caitlin Thompson, BSc student, of the University of Reading, and Lucy Feighery, MSc, of Berkshire Healthcare NHS Foundation Trust, for help with abstract screening, data extraction, and quality rating; and Sally Smith, MLS, of the University of Reading, for help with bibliographic / literature search issues. They also thank Joseph Biederman, MD, of Harvard Medical School; David Brent, MD, of the University of Pittsburgh; Helen Dodd, PhD, of the University of Reading; Daniel Klein, PhD, of Stony Brook University; Susanne Knappe, PD Dr.Dipl-Psych, of Technische Universitat Dresden; Autumn Kujawa, PhD, of Vanderbilt University; Anna Manelis, PhD, of the University of Pittsburgh; Daniel Pine, MD, of the National Institute of Mental Health; Krishnamachari Srinivasan, MD, of St John’s Medical College, Bangalore, India; Lisa Starr, PhD, of Stony Brook University; and Erin Tone, PhD, of Georgia State University, for responding to our requests for data.

Disclosure: Drs. Lawrence, Murayama, and Creswell report no biomedical financial interests or potential conflicts of interest.