The role of childhood generalized anxiety in the internalizing cluster

Abstract

Background Anxiety, depression and somatization (the internalizing cluster) are highly comorbid, prevalent and associated with significant individual and societal costs. Although prior studies have examined their natural course, there has been a little investigation into how symptoms unfold at the individual level. We examined the intraindividual (within-person) temporal patterning of symptom development and the impact of risk factors (sex, ethnicity, socioeconomic indicators, bullying victimization, child maltreatment) on symptom means and trajectories (between-person), comparing youth and parent reports. Method Over a 7-year interval from age 11 to 17, children (n = 669; 54% girls; 79% White) and parents (89% mothers) reported on symptoms of anxiety and depression from age 11 and somatization from age 13. Autoregressive latent trajectory models with structured residuals were used to uncouple within- and between-person sources of variance. Results According to self-reports, generalized anxiety consistently predicted depression, while anxiety and depression consistently predicted somatization. Anxiety also had an indirect effect on somatization via depression. According to parent reports, there were several bidirectional effects between anxiety and depression and between depression and somatization. Experiences of abuse were consistent risk factors for self-reported internalizing symptoms, and across informants, girls had higher symptom means and rising trajectories compared to boys. Conclusion Generalized anxiety plays an important role in adolescent depressive and somatic symptoms. Primary prevention of anxiety may be warranted to curb symptom continuity and the development of comorbidity. Research is needed to determine whether self-reports of anxiety should be prioritized over parent reports and continued efforts are needed to reduce bullying and child maltreatment.

The mediating role of anxiety/depression symptoms between adverse childhood experiences (ACEs) and somatic symptoms in adolescents

“…This result aligns with the existing literature that consistently demonstrates the strong concurrent association between anxiety/depression symptoms and somatic symptoms in adolescents (Agnafors et al, 2019;Crawley et al, 2014;Janssens et al, 2010;J. H. J. Kim et al, 2019;Lallukka et al, 2019;Lee & Vaillancourt, 2019;Shanahan et al, 2015;Soltani et al, 2019). In contrast to our hypothesis, there were negative relationships between anxiety/depression symptoms and future somatic symptoms.…”

The perinatal origins of childhood anxiety disorders and the role of early-life maternal predictors

“…Overall, these findings from our longitudinal study, albeit derived from observational data, provide preliminary evidence that is consistent with an association between early-life maternal risk factors and CAD in offspring. The implied aetiological model of CAD, which our findings suggest, is one that is likely to be multifactorial, trans-generational and where maternal factors operating pre-conception as far back as early-life trauma, as well as factors in pregnancy and the postpartum are all vital to understand the early development of CAD (Glover, 2011; Glover et al, 2010; Lee & Vaillancourt, 2019; Murray, Creswell, & Cooper, 2009). The role of cortisol in understanding maternal mental health and child outcomes that we found is consistent with reviews and commentaries where there is not a simple relationship with either maternal or child outcomes (Galbally et al, 2019a; Zijlmans et al, 2015).…”

Assessing the quality of research examining change in children’s mental health in the context of COVID-19

“…Autoregressive latent trajectory models with structured residuals are now being used to provide stringent tests of within-person cross-lagged associations. Using this analytic approach, Lee and Vaillancourt 12 examined the intraindividual (within-person) temporal patterning of internalizing symptom development in a sample of 669 Canadian children and youth assessed yearly from age 11 to 17, and found that generalized anxiety consistently predicted depression, while anxiety and depression consistently predicted somatization. Of note, anxiety also had an indirect effect (mediating) on somatization via depression.…”

“…These results suggest that focusing on anxiety could potentially help "curb symptom continuity and the development of comorbidity." 12 Longitudinal research is complicated. In addition to planning and collecting data, which takes time, the analysis must be carefully selected to answer the specific a priori research question and the conclusions must be precisely drawn to match the specific analytic approach used.…”

“…24 For example, children and youth often systematically drop out of studies because of their mental health difficulties and/or behavioural problems (see Wolke et al 25 for example). It is also common to lose participants from lower socioeconomic brackets and racialized communities (see Lee and Vaillancourt 12 for example). Accordingly, attrition must be carefully considered in the study design.…”