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

Abstract Background The development of childhood anxiety disorders (CADs) is likely to depend on pathways that can be programmed by early-life risk factors. We test the hypothesis that early-life maternal factors can predict this programming effect on CAD. Methods Data were obtained from 198 women and children from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS), a cohort study with data collected across pregnancy, postpartum and until 4 years of age. Maternal antenatal depression was measured using the Structured Clinical Interview for DSM-IV (SCID-IV), together with antenatal hair cortisol concentrations, maternal childhood trauma and parenting stress at 6 months postpartum. CAD was assessed with the Preschool Age Psychiatric Assessment and the Child Behaviour Checklist. Results Antenatal depression, a history of maternal childhood trauma and lower gestational age at birth were each associated with anxiety disorders at 4 years of age in their children. A multivariate binary logistic model with these early predictors explained approximately 9% of variance in CAD outcome at 4 years of age; however, only maternal trauma and gestational age were significant predictors in the model. The effect of early parenting stress on CAD was found to vary by the concentration of maternal antenatal hair cortisol, whereby postpartum parenting stress was associated with CAD only when there were higher maternal antenatal cortisol levels. Conclusions This study suggests the importance of maternal factors pre-conception, pregnancy and in the postnatal period, which predict CADs and this is consistent with a developmental programming hypothesis for CAD.

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Prenatal predictors of childhood anxiety disorders: An exploratory study of the role of attachment organization

Development and Psychopathology ◽

10.1017/s0954579421001206 ◽

2021 ◽

pp. 1-12

Author(s):

Megan Galbally ◽

Stuart J. Watson ◽

Marinus H. van IJzendoorn ◽

Anne Tharner ◽

Maartje Luijk ◽

...

Keyword(s):

Anxiety Disorders ◽

Life Stress ◽

Exploratory Study ◽

Early Life ◽

Early Life Stress ◽

Childhood Anxiety ◽

Preschool Age ◽

Hair Cortisol ◽

Cortisol Reactivity ◽

Childhood Anxiety Disorders

Abstract Childhood anxiety disorders (CAD) are a common childhood mental disorder and understanding early developmental pathways is key to prevention and early intervention. What is not understood is whether early life stress predictors of CAD might be both mediated by infant cortisol reactivity and moderated by infant attachment status. To address this question, this exploratory study draws on 190 women recruited in early pregnancy and followed together with their children until 4 years of age. Early life stress is operationalized as maternal depression measured using the Structured Clinical Interview for the DSM, Childhood Trauma Questionnaire, Parenting Stress Index, and antenatal maternal hair cortisol concentrations. Infant cortisol reactivity was measured at 12 months together with the Strange Situation Procedure and CAD assessed at 4 years of age using the Preschool Age Psychiatric Assessment. There was no direct association between attachment classification and CAD. Furthermore, infant cortisol reactivity neither mediated nor attachment moderated the association of early life stress predictors and CAD. However, only for infants with organized attachment classifications, higher maternal antenatal depression, and hair cortisol were associated with a higher risk of CAD.

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Highlights of this issue

The British Journal of Psychiatry ◽

10.1192/bjp.203.6.a22 ◽

2013 ◽

Vol 203 (6) ◽

pp. A22-A22

Author(s):

Kimberlie Dean

Keyword(s):

Eating Disorders ◽

Randomised Controlled Trial ◽

Anxiety Disorders ◽

Early Life ◽

Controlled Trial ◽

Childhood Anxiety ◽

Childhood Anxiety Disorders ◽

Low Intensity ◽

Randomised Controlled ◽

Diagnostic Outcomes

Interventions throughout early life - antenatally, in childhood and in adolescenceTwo papers in the Journal this month describe trials of interventions targeting young people – one focused on treating anxiety disorders in childhood and another on preventing eating disorders in adolescence. While CBT for childhood anxiety disorders is known to be effective, its availability is limited. Thirlwall et al (pp. 436–444) conducted a randomised controlled trial of low-intensity guided parent-delivered CBT in a sample of children with anxiety disorders referred by primary or secondary care to a specialist clinic. Compared with waiting-list controls, the children receiving the full intervention demonstrated superior diagnostic outcomes, whereas those receiving a brief version of the intervention showed no improvements. In a linked editorial, Cartwright-Hatton (pp. 401–402) highlights the prevalence of childhood anxiety disorders, the implications of failing to treat them and the evidence supporting their treatability. She also points to the implications of findings from Thirlwall et al indicating that therapists need not be highly trained or experienced to achieve significant results.

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