Childhood Separation Anxiety and the Risk of Subsequent Psychopathology: Results from a Community Study

Department of Clinical Psychology and Epidemiology, Max Planck Institute of Psychiatry, Munich, Germany.
Psychotherapy and Psychosomatics (Impact Factor: 9.2). 02/2007; 76(1):47-56. DOI: 10.1159/000096364
Source: PubMed


To examine the association between separation anxiety disorder (SAD) and mental disorders in a community sample and to evaluate whether separation anxiety is specifically related to panic disorder with and without agoraphobia.
The data come from a 4-year, prospective longitudinal study of a representative cohort of adolescents and young adults aged 14-24 years at baseline in Munich, Germany. The present analyses are based on a subsample of the younger cohort that completed baseline and two follow-up investigations (n = 1,090). DSM-IV diagnoses were made using the Munich Composite International Diagnostic Interview. Cox regressions with time-dependent covariates were used to examine whether prior SAD is associated with an increased risk for subsequent mental disorders.
Participants meeting DSM-IV criteria for SAD were at an increased risk of developing subsequent panic disorder with agoraphobia (PDAG) (HR = 18.1, 95% CI = 5.6-58.7), specific phobia (HR = 2.7, 95% CI = 1.001-7.6), generalized anxiety disorder (HR = 9.4, 95% CI = 1.8-48.7), obsessive-compulsive disorder (HR = 10.7, 95% CI = 1.7-66.1), bipolar disorder (HR = 7.7, 95% CI = 2.8-20.8), pain disorder (HR = 3.5, 95% CI = 1.3-9.1), and alcohol dependence (HR = 4.7, 95% CI = 1.7-12.4). Increased hazard rates for PDAG (HR = 4.2, 95% CI = 1.4-12.1), bipolar disorder type II (HR = 8.1, 95% CI = 2.3-27.4), pain disorder (HR = 1.9, 95% CI = 1.01-3.5), and alcohol dependence (HR = 2.1, 95% CI = 1.1-4.) were also found for subjects fulfilling subthreshold SAD.
Although revealing a strong association between SAD and PDAG, our results argue against a specific SAD-PDAG relationship. PDAG was neither a specific outcome nor a complete mediator variable of SAD.

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Available from: Silvia Schneider, Aug 15, 2014
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    • "However findings on the role of SAD in the development of other disorders in adulthood are mixed. In some studies, SAD was reported to increase the risk of other disorders (e.g., panic disorder, MDD) (Bittner et al., 2004; Brückl et al., 2007: Lewinsohn et al., 1998), whereas other studies failed to replicate this association (Aschenbrand et al., 2003; Hayward et al., 2000; Silove et al., 1996). Furthermore, SAD tends to have a short duration of about 3 years (Lewinsohn et al., 1998). "
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    ABSTRACT: Anxiety disorders are associated with adverse psychosocial functioning, and are predictive of a wide range of psychiatric disorders in adulthood. The present study examined the associations between anxiety disorders during childhood and adolescence and psychosocial outcomes at age 30, and sought to address the extent to which psychopathology after age 19 mediated these relations. Eight hundred and sixteen participants from a large community sample were interviewed twice during adolescence, at age 24, and at age 30. They completed self-report measures of psychosocial functioning and semi-structured diagnostic interviews during adolescence and young adulthood. Adolescent anxiety predicted poor total adjustment, poor adjustment at work, poor family relationships, problems with the family unit, less life satisfaction, poor coping skills, and more chronic stress. Adolescent anxiety predicted, substance (SUD), alcohol abuse/dependence (AUD), and anxiety in adulthood. No adult psychopathology mediated the relationship between childhood anxiety disorders and psychosocial outcomes at age 30. Adult, SUD, AUD and anxiety mediated the association between adolescent anxiety and most domains of psychosocial functioning at age 30. The participants are ethically and geographically homogenous, and changes in the diagnostic criteria and the interview schedules across the assessment periods. Adolescent anxiety, compared to childhood anxiety, is associated with more adverse psychosocial outcomes at age 30. Adolescent anxiety affects negative outcomes at age 30 directly and through adult anxiety, SUD and AUD.
    Journal of Affective Disorders 01/2014; 163. DOI:10.1016/j.jad.2013.12.033 · 3.38 Impact Factor
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    • "Authors commented that CSAD might represent an antecedent to adult-onset PD. However, further research has revealed mixed findings, and prospective follow-up studies confirmed that CSAD – compared to those with other anxiety diagnoses – was related to more anxiety disorders in general and distinct psychiatric disorders, but not specifically to PD (Aschenbrand et al., 2003; Brückl et al., 2007; Lipsitz et al., 1994; Silove et al., 1993a). Thus, inconsistencies on the specificity between CSAD, and adult PD are still bearing an unresolved controversy . "
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    ABSTRACT: Adults with panic disorder (PD) and children with separation anxiety disorder (CSAD) show higher reactivity to CO(2). Our hypothesis was patients with adult separation anxiety disorder (ASAD) would show similar hypersensitivity to CO(2). In the present study, we determined whether sensitivity to CO(2) was enhanced in adult patients with separation anxiety disorder with no history of panic attacks. Patients with PD (n=38), adult separation anxiety disorder (ASAD) patients with no history of panic attacks (n=31), and healthy subjects (n=40) underwent a 35% CO(2) inhalation challenge procedure. Baseline and post-inhalation anxiety were assessed with the Acute Panic Inventory, Visual Analog Scale, and Anxiety Sensitivity Index-3 (ASI-3). As hypothesized the rate of CO(2)-induced panic attacks was significantly greater in PD and ASAD patient groups (55.3% and 51.6% respectively) than healthy comparison group (17.5%). Nine (69.2%) of 13 patients in PD group who have ASAD concurrent with PD had a CO(2)-induced panic attack. ASI-3 total scores were not different between PD and ASAD groups and both were significantly higher than controls. However, anxiety sensitivity did not predict the occurrence of panic attacks. The researchers were not blind to the diagnosis and there was no placebo arm for comparison. Besides, parameters of respiratory physiology were not evaluated. ASAD was associated with CO(2) hypersensitivity quite similar to PD. This finding partly unfolds the complex relationship of 'CSAD, PD, and CO(2) hypersensitivity' and indicates that CO(2) hypersensitivity and separation anxiety extend together beyond childhood.
    Journal of Affective Disorders 04/2012; 141(2-3):315-23. DOI:10.1016/j.jad.2012.03.032 · 3.38 Impact Factor
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    • "So konnten Woodward und Fergusson (2001) in ihrer Längsschnittstudie mit 1265 Kindern aus Neuseeland zeigen, dass das Vorliegen einer Angststörung im Kindesalter die Wahrscheinlichkeit erhöht, im Erwachsenenalter Angststörungen, Depressionen oder Suchterkrankungen zu entwickeln. Sowohl Schneider und Nündel (2002) als auch Brückl et al. (2007) fanden insbesondere für die Trennungsangst im "
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    ABSTRACT: Anxiety disorders are among the most frequent psychological disorders in childhood and adolescence. They are characterized by early onset, tend to remain stable over time, and act as a significant risk factor for developing a psychological disorder in adulthood. Over the last few years, research has shown that anxiety disorders in children and adolescents can be treated effectively. However, to date only cognitive behavioral therapy (CBT) has received convincing empirical support as an effective psychotherapeutic treatment. Evidence for the effectiveness of other psychotherapeutic treatments such as nonbehavioral family therapy or psychodynamic interventions is rather scant. Recent randomized controlled trials (RCT) proved CBT to be effective from preschool age onwards. Contrary to long-held beliefs, however, the involvement of parents in a treatment program does not appear to be crucial to therapeutic outcome. Issues regarding the effectiveness of disorder-specific treatments and the combination of psychotherapeutic treatments with the application of selective serotonin reuptake inhibitors (SSRIs) are increasingly being taken up in recent studies. In addition to «classic» cognitive behavioural treatment programs there are some promising suggestions for the effectiveness of novel treatment methods such as attention bias modification or computer-assisted behavioral therapy.
    Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 01/2012; 40(1):21-8. DOI:10.1024/1422-4917/a000146 · 0.99 Impact Factor
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