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Age, gender and negative life events in anxiety and depression self-reports at preadolescence and early adolescence

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Objective: To examine the associations between age, gender, negative life events and anxiety and depressive symptoms in preadolescents and early adolescents. Method: A cluster sampling procedure was used for this cross-sectional study, with 1.514 randomly selected 4th to 6th grade pupils attending 13 randomly selected schools in Reus (Catalonia). Information on negative life events and anxiety and depression symptoms was collected by means of self-reports. Results: Through linear regression models, significant negative associations were found between age, general anxiety and panic and separation anxiety symptoms. A significant positive association was found between age and generalized anxiety symptoms. Girls obtained significantly higher scores for almost all types of anxiety symptoms: separation anxiety, panic, generalized anxiety and general anxiety. General anxiety, depressive symptoms and generalized anxiety symptoms were significantly more associated with negative life events. Conclusion: age, gender and negative life events are important factors in the manifestation of anxiety and depression.
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AGE, GENDER AND NEGATIVE LIFE EVENTS IN ANXIETY AND
DEPRESSION SELF-REPORTS AT PREADOLESCENCE AND EARLY
ADOLESCENCES
Teodora Cosmina Zolog*, Ma Claustre Jané- Ballabriga*, Albert Bonillo-Martin**,
Josefa Canals-Sans***, Carmen Hernandez-Martinez***, Kelly Romero-Acosta*,
y Eldemira Domenech-Llaberia*
Ansiedad
y
Estrés
ISSN: 1134-7937
2011, 17(2-3), 113-124
*Department of Health and Clinical Psychology, Universitat Autònoma de Barcelona
** Department of Psychobiology and Methodology, Universitat Autònoma de
Barcelona
*** Department of Psychology, Universitat Rovira i Virgili, Tarragona
Abstract: Objective: To examine the associations
between age, gender, negative life events and anxi-
ety and depressive symptoms in preadolescents and
early adolescents. Method: A cluster sampling pro-
cedure was used for this cross-sectional study, with
1.514 randomly selected 4th to 6th grade pupils at-
tending 13 randomly selected schools in Reus
(Catalonia). Information on negative life events
and anxiety and depression symptoms was col-
lected by means of self-reports. Results: Through
linear regression models, significant negative asso-
ciations were found between age, general anxiety
and panic and separation anxiety symptoms. A sig-
nificant positive association was found between
age and generalized anxiety symptoms. Girls ob-
tained significantly higher scores for almost all ty-
pes of anxiety symptoms: separation anxiety, pa-
nic, generalized anxiety and general anxiety. Ge-
neral anxiety, depressive symptoms and general-
ized anxiety symptoms were significantly more
associated with negative life events. Conclusion:
age, gender and negative life events are important
factors in the manifestation of anxiety and de-
pression.
Key words: age, gender, anxiety, self-report,
preadolescents.
Resumen: Objetivos: examinar las asociaciones en-
tre edad, género, acontecimientos vitales estresantes
y la sintomatología ansiosa y depresiva. Método: a
partir de un muestreo aleatorio por conglomerados,
se seleccionó a 1514 estudiantes de Educación Pri-
maria, de 8 a 13 años, procedentes de 13 colegios de
Reus (Cataluña). La información acerca de la sinto-
matología ansiosa, depresiva y sobre los aconteci-
mientos estresantes se recogió mediante autoinfor-
mes. Resultados: a través de modelos de regresión
lineal, se obtuvieron asociaciones negativas –y signi-
ficativas- entre edad, ansiedad general, pánico y an-
siedad de separación. Se halló asociación positiva y
significativa entre edad y ansiedad generalizada. Las
chicas obtuvieron puntuaciones más altas que los
chicos en los siguientes tipos de ansiedad: ansiedad
de separación, pánico, ansiedad generalizada y an-
siedad en general. La ansiedad en general, los sínto-
mas depresivos y la ansiedad generalizada son las
escalas que más se asocian con los acontecimientos
vitales estresantes. Conclusiones: la edad, el género
y los acontecimientos vitales estresantes son factores
importantes en la expresión de la sintomatología an-
siosa y depresiva.
Palabras clave: burnout, hardy personality, sense of
coherence, critical care.
Título: Edad, género y acontecimientos
vitales estresantes en autoinformes
de ansiedad y depresión en preado-
lescencia y adolescencia temprana
Introducción
Epidemiological studies have shown
that approximately 10 - 20% of children
*Dirigir la correspondencia a:
Teodora Cosmina Zolog
Departament de Psicologia Clínica i de la Salut, Universitat
Autònoma de Barcelona. Edifici B Facultat Psicologia.
Campus UAB, 08193. Bellaterra (Cerdanyola del Vallès)
e-mail: dorazolog@gmail.com
© Copyright 2011: de los Editores de
A
nsiedad
y
E
strés
and youth suffer from an anxiety disorder,
and half as many suffer functional impair-
ment as a result of anxiety or phobias
(Marmostein, 2006; Merikangas, 2005).
To better understand anxiety manifesta-
tion in children and adolescents, gender
and age must be taken into account because
the effect of these variables plays a promi-
Cosmina Zolog et al.
114
nent role in the development and expre-
ssion of child and adolescent anxiety
symptomatology. In this regard, girls tend
to have more internalizing symptoms, in-
cluding anxiety symptoms or disorders
across all developmental phases (Hale,
Raaijmakers, Muris, & Meeus, 2005; Lin-
yan, Fang, Yi, & Xueping, 2007; Merikan-
gas, 2005; Simonoff et al., 1997). The re-
sults of studies that employ self-reports are
consistent with these findings, with girls
reporting significantly more anxiety
symptoms than boys for all types of anxiety
symptoms. Moreover, these gender diffe-
rences seem to be the same across different
cultures. For instance, in a German popula-
tion, Essau, Muris, and Ederer (2002)
found that girls were at higher risk than
boys on all scales of the Screen for Child
Anxiety Related Emotional Disorders
(SCARED; Birmaher et al., 1997, 1999).
The same results were found in a Japanese
sample of preadolescents and early adoles-
cents (e.g., Essau, Sakano, Ishikawa & Sa-
sagawa, 2004). Likewise, girls from South
Africa (e.g., Muris, Schmidt, Engelbrecht,
& Perold, 2002), reported higher levels of
anxiety on all anxiety factors and total
score of SCARED (general anxiety). Ex-
planations for these marked gender diffe-
rences were offered by various epidemio-
logical studies, including ideas about ge-
netic predispositions or the implications of
biological factors (see Simonoff et al.,
1997).
With respect to the effects of age in
anxiety symptomatology, Warren and
Stroufe (2004) and Westenberg, Siebelink,
and Treffers (2001) have presented models
of the specific age differences in the ex-
pression of childhood anxiety symptoms.
These models suggest that expressions of
anxious symptoms are tied to normative
development periods and challenges (Wa-
rren & Stroufe, 2004). Separation anxiety
symptoms seem to be more common in
children around ages 6-9 years, generalized
anxiety symptoms around ages 10-13
years, and social anxiety symptoms in ado-
lescents around ages 14-17 years.
There is well established evidence
through empirical studies the link between
a normal development and the expression
of anxiety (Chorpita, Yim, Moffit, Ume-
moto & Francis, 2000; Weems & Costa,
2005). However, in community studies of
preadolescents and adolescents using an-
xiety self-reports, findings are diverse, with
many different outcomes. Evidence about
patterns of anxiety symptoms and age di-
fferences comes from studies that
employed the SCARED (Birmaher et al.,
1997; Birmaher et al., 1999). For instance,
small significant negative associations were
found by Muris et al. (2002) between sepa-
ration anxiety symptoms and age. In the
same line, Essau et al. (2002) found a sig-
nificant age effect for separation anxiety
which declines with age, and generalized
anxiety that tended to increase slightly but
significantly with age. In a sample of 8 to
16 year olds, Linyan et al. (2007) found
significant positive associations between
age and almost all factors, except separa-
tion anxiety symptoms, which decline sig-
nificantly with age. In a community sample
of preadolescents and adolescents, Muris,
Schmidt, and Merckelbach (2000) found
significant negative associations between
age and separation anxiety symptoms,
panic symptoms, social anxiety symptoms
and total SCARED score. A significant
positive association was found between
generalized anxiety symptoms and age
(Muris et al., 2000). Hale et al. (2005) con-
ducted a study using a sample of 1.304
preadolescents and adolescents (10 to 18
years old) and found a significant negative
association between age and separation
anxiety symptoms. Between age and gene-
ralized anxiety symptoms and school pho-
bia symptoms they found significant posi-
tive associations. Regarding school phobia
and age, however, Essau et al. (2002)
Age, gender and negative life events in anxiety and depression at pre- and early adolescence
115
found no significant associations in preado-
lescent and early adolescent samples (8 to
12 year olds).
In a community sample of adolescents
from Spain, Olivares Rodríguez, Piqueras
Rodríguez and Alcázar (2006) found more
girls than boys suffering from social pho-
bia, but in the same study no significant as-
sociation between age and social phobia
was found. Using anxiety self-reports, Gar-
cía-Villamisar, Vidal and Yenes (2002)
examined the associations between age,
gender and anxiety symptoms and found
that girls scored higher than boys on social
phobia symptoms and children and preado-
lescents scored higher than adolescents on
separation anxiety symptoms.
Previous studies using a community
sample of preadolescents and early adoles-
cents and the SCARED as the anxiety self-
report indicated that girls have a higher risk
of suffering from anxiety disorders than
boys (Romero-Acosta et al., 2010; Vigil-
Colet et al., 2009). Vigil-Colet et al.(2009)
analyzing the associations between age,
gender and anxiety symptoms found that
girls scored higher than boys on separation,
generalized, social and general anxiety
symptoms. Older children scored higher on
generalized anxiety symptoms and younger
children scored higher on separation an-
xiety symptoms. We should mention that in
the study by Romero-Acosta et al. (2010),
the authors documented only the frequency
of girls and boys at risk of anxiety disor-
ders and Vigil-Colet et al. (2009) reported
age and gender differences on anxiety
symptoms after performing a factor analy-
sis without taking into account the original
scale developed by Birmaher et al. (1997).
There is a growing body of evidence
suggesting positive associations between
negative life events and depressive and
anxiety symptoms or disorders. In these re-
gard, studies found that adults with panic
disorder, generalized anxiety disorder, and
social phobia were more likely to report a
history of childhood adversity than the con-
trol groups (Brown & Harris, 1989). In a
Spanish population of children and adoles-
cents, Pedreira (1998) found that change of
school or household, parents’ divorce,
death of a father, and illness of a mother
were all associated with separation anxiety
disorder in children. Nevertheless, whether
potentially traumatic events are differen-
tially linked to anxiety, types of anxiety
and depression has not been sufficiently in-
vestigated. A large amount of studies have
found that traumatic events are more re-
lated to depression. In the study by Wil-
liamson, Birmaher, Dahl and Ryan (1999),
traumatic events (e.g., death of a father)
were significantly more prevalent among
depressed children compared to anxious
children. In the study by Tiet et al. (2001),
four disorders were significantly more
associated with the majority of the 25 ad-
verse life events examined: Conduct Disor-
der (22 adverse life events), Oppositional
Defiant Disorder (21 adverse life events),
Major Depressive Disorder (19 adverse life
events), Overanxious Anxiety and Separa-
tion Anxiety (11 and 8 negative life events,
respectively). On the other hand, social
phobia was related to very few negative life
events.
Given the great diversity of outcomes
found in studies that have used the
SCARED and the lack of studies that have
measured anxiety symptoms and, particu-
larly, the different types of anxiety symp-
toms through self-reports in Spain, we
aimed to explore the associations between
gender and age, on one hand, and anxiety
symptoms, on the other, employing the
SCARED in a community sample of 1.514
preadolescents and early adolescents from
Catalonia (Spain). Taking into account that
other previous studies examined age and
gender differences in anxiety symptoms
using the same sample as the one assessed
in the present study (see Vigil-Colet et al.,
Cosmina Zolog et al.
116
2009), we analyzed the associations
between age, gender and anxiety symptoms
using the original scale developed by Bir-
maher et al. (1997) and, at the same time,
using linear regression equations. We con-
sider that this statistical method enables the
control of a series of confounding va-
riables. Furthermore, it offers more accu-
rate and adjusted outcomes, minimizing
biases with regard to the associations
between age, gender and anxiety symp-
toms.
The second aim of our study is to test
whether negative life events are associated
with depressive and anxiety symptoms
(general, separation and generalized anxi-
ety, social phobia or panic symptoms).
According to previous research, we ex-
pect to find significant negative associa-
tions between age and separation anxiety
symptoms and the total SCARED score;
significant positive associations between
age and generalized anxiety, panic and so-
cial anxiety symptoms.
Regarding the association between gen-
der and anxiety symptoms we hypothesized
that there would be significant gender di-
fferences, with girls scoring higher than
boys in almost all types of anxiety
symptoms: separation anxiety, panic, so-
cial, generalized anxiety symptoms and to-
tal SCARED score.
With regard to the associations between
depressive, anxiety symptoms and negative
life events we hypothesized that negative
life events would be associated with de-
pressive symptoms and with general an-
xiety. In addition, we hypothesized that
negative life events would be more asso-
ciated with generalized and separation
anxiety symptoms than other types of an-
xiety symptoms.
Method
Participants
This project is part of a large cross-
sectional study and consists of two phases,
only the first of which is described here.
Cluster sampling was conducted by ran-
domly selecting a set of 13 schools (7 state
schools and 6 state-subsidized private
schools) from the total of 26 schools (17
Table 1. Socio-demographic characteristics of 1,514 participants.
Category N (%)
Gender Male
Female
719
795
47.5
52.5
Age
8
9
10
11
12
13
MEAN 10.23
SD 1,235
8
348
496
512
135
6
0.5
23.1
33.0
34.0
9.0
0.4
Socio-Economic
Status
Low
Middle
High
463
920
130
30.6
60.8
8.6
Race
Spanish
Hispanics from America
European
Africans and Moroccan
Others
1324
95
30
39
15
88.1
6.3
2.0
2.6
1.0
Age, gender and negative life events in anxiety and depression at pre- and early adolescence
117
state and 9 state-subsidized private schools)
and from all five representative areas of
Reus (Catalonia, Spain), a medium-sized
town with 100,000 inhabitants. Two thou-
sand and twenty three pupils were invited
to participate, but only 1,514 pupils co-
rrectly completed the self-reports, repre-
senting 46.9% of the total number of chil-
dren between 4th and 6th registered in all
schools from Reus. Eighty percent of pa-
rents agreed to participate in the study.
Of the 1,514 questionnaires, 18 ques-
tionnaires were excluded due to incomplete
or missing data. Table 1 gives the socio-
demographic characteristics of all 1,514
students who participated, almost all of
whom were Spanish (1,324: 88.1%). Seven
hundred and nineteen children (47.5%)
were male and 795 (52.5%) female. The
age of the children ranged from 8 to 13
years old (M = 10.23; SD = 1.235).
Instruments
The instruments used in the first stage
of the research were:
An ad-hoc demographic questionnaire
created for this study which asked children
to report their age, grade, gender, country
of birth, and family composition. Also, the
demographic questionnaire requested in-
formation about the negative life events, in
which children were asked to relate the
most important negative life events in the
last year of their lives.
The Hollingshead scale (Hollingshead,
1975) for the social class distribution of pa-
rents;
The Child Depression Inventory (CDI;
Kovacs, 1983; Monreal, 1988) for depre-
ssive symptomatology in children.
The SCARED (Birmaher et al., 1997;
Birmaher et al., 1999) was developed to
screen for symptoms of some DSM-IV
anxiety disorders, namely generalized
anxiety disorder, separation anxiety disor-
der, panic disorder, social and school pho-
bias. There are several versions of the
SCARED; the 41-item version was used
(Birmaher et al., 1999) for this study. In
community samples of Spanish children
and adolescents (Domenech-Llaberia &
Martínez, 2008), good internal consistency
was obtained with a .83 global Cronbach’s
alpha. The results obtained for each factor
were a Cronbach’s alpha of .44 for school
avoidance, .67 for social phobia, .68 for
generalized anxiety and separation anxiety,
and .72 for panic disorder. Test-retest re-
liability was .72. Concurrent validity was
evaluated in relation to the STAIC (Spiel-
berger, 1973). This relationship is signifi-
cantly stronger with the STAIC- trait (.58).
In the present sample and using the original
scale developed by Birmaher et al. (1999)
the internal consistency of the full scale
and of each scale appeared sufficient (with
Cronbach’s alphas varying between .73 and
.78).
Procedure
Our research was approved by the Hu-
man Research Ethics Committee of Rovira
i Virgili University (Tarragona, Spain).
This first stage of research assesses pupils
as the sole informants. After written paren-
tal consent forms were received, partici-
pants were administered the questionnaires
in groups in each classroom, with two
assistant researchers attending each class-
room. All participants read a standardized
set of instructions, advising participants to
read each item and select the answer that
seemed most appropriate. Additionally, we
were able to review the questionnaires im-
mediately after completion and address in-
complete questionnaires. Confidentiality
was assured. Children were excluded if
they had a history of one or more of the
following diagnoses: pervasive develop-
mental disorder, mental retardation, schizo-
phrenia and other psychotic disorders. In-
formation regarding the above diagno-
ses was obtained from teachers and school
reports. Children who were unable to read
Cosmina Zolog et al.
118
and understand Spanish were also ex-
cluded.
Data Analysis
Linear regression models were used to
determine the associations between the
predictor variables and all continuous va-
riables of anxiety symptoms as outcome
variables.
We built six separated regression mo-
dels in which the outcome variables were
panic symptoms, social phobia symptoms,
school avoidance symptoms, separation
anxiety symptoms, generalized anxiety
symptoms and general anxiety (SCARED
total score).The predictor variables were
age, gender and negative life events. Girls
were categorized with 0 and boys with 1.
We created the variable age x gender by
multiplying age by gender. The interaction
term age x gender was introduced in each
regression model. In order to reduce the
multicollinearity the variable age was cen-
tered. Depressive symptoms, socio-
economic status and chronic health pro-
blems as potential confounders were intro-
duced in each regression equation in order
to minimize biases and ensure the most
parsimonious findings.
We have not presented here the full sta-
tistic for the equations, as our regression
equations had an explanatory rather than
predictive purposes (see Kleinbaum, Kup-
per & Morgenstern, 1982).
In order to show the associations
between negative life events and depressive
symptoms we built a regression model in
which the outcome variable was depressive
symptoms and the predictor variable was
negative life events. Age, gender, general
anxiety, socio-economic status and chronic
problems were introduced as control va-
riables.
All variables were introduced simulta-
neously into the equation through the enter
method (Cox & Snell, 1989; Domenech &
Navarro, 2005; Hosmer & Lemeshow,
1989). All analyses were performed on
SPSS, version 13.
Results
Table 2 shows the main significant
Table 2. Associations between types of anxiety symptoms and age, gender and negative life
events
General Anxiety
(Total Score)
Panic symptoms Separation anxiety
B CI 95% p B CI 95% p B CI 95% p
Gender 1.86
.99:2.73
R²:011
.000 .17 -.17 : .51
R²:001
.33 .41 .15:.67
R²:008
.002
Age -.66 -.1.11:-.20
R²:002
.004 -.31
-.50:-13
R²:003
.001 -.54 -.68:-.41
R²:027
.000
Age x
Gender
-.63 -1.70:.42 .24 -.21 -.58:.14 .24 -.03 -.30:.24 .83
Socio-economic
status
-.82 -.2.38:.74 .30 -.82 -1.44:-.13 .01 -.05 -.53:.41 .81
Negative life
events
2.86 1.96:3.76
R²:068
.000 .59 .23:.95
R²:034
.001 .61 .34:.88
R²:036
.000
Chronic
problems
1.20 -.93:3.33 .26 .85 -.001:1.70 .05 .30 -.33:.95 .35
Depressive
symptoms
.88 .81:.95 .000 .29 .26:.32 .00 .18 .16:.20 .000
R² values for the
full models
.334*
.242*
.211*
Age, gender and negative life events in anxiety and depression at pre- and early adolescence
119
associations between age and gender, on
one hand, and the subscales and total score
of the SCARED, on the other. In this re-
gard, there were significant negative asso-
ciations between age and panic symptoms
(p < .001), separation anxiety symptoms (p
< .001) and the total SCARED score (p <
.004); a significant positive association
between generalized anxiety symptoms and
age (p < .001), with higher generalized
anxiety symptoms scores in older children.
Girls seem to have significantly higher
scores compared to boys for almost all
types of anxiety symptoms: total SCARED
score (p < .001), generalized anxiety symp-
toms (p < .006), separation anxiety symp-
toms (p < .002) and social anxiety symp-
toms (p < .001).
Additional analyses revealed no
substantial associations between age x gen-
der and types of anxiety symptoms.
Our results also revealed the associa-
tions between general anxiety, types of
anxiety symptoms and negative life events
(see Table 2). There were positive signifi-
cant associations between negative life
events on one hand and general anxiety (p
< .001), panic symptoms (p < .001), sepa-
ration anxiety symptoms (p < .001), gene-
ralized anxiety (p < .001), social phobia (p
< .02) and school phobia (p < .01), on the
other.
Between negative life events and de-
pressive symptoms there was a positive
significant association (p < .001) (see Table
3).
Furthermore, Table 2 reveals the esti-
mates of variance for the full regression
models and for age, gender and negative
life events. In this regard, the full regre-
ssion models are all significant and the
variance explained varied from 9% (re-
garding the social phobia symptoms) to 34
% (for depressive symptoms). The variance
explained by age and gender variables va-
ried between 1% and 2% and the variance
explained by negative life events varied
between 1% and 7%.
Discussion
Regarding gender differences in the
prevalence of anxiety symptoms, in our
study girls scored higher in almost all types
Table 2 (continuation). Associations between types of anxiety symptoms and age, gender
and negative life events
Generalized Anxiety Social anxiety School phobia
B CI 95% p B CI 95% p B CI 95% p
Gender .41 .11:.71
R²:006
.006 .74 .46:1.03
R²:018
.000 .07 -.03:.19
R²:001
.17
Age .29 .13:.45
R²:011
.000 -.04 -.19:.10
R²:000
.57 -.05 -.11:.00
R²:001
.08
Age x
Gender
-.11 -.42:.19 .47 -.47 -.77:.17 .32 -.07 -.19:.04 .23
Socio-economic
status
-.26 -.79:.27 .33 .16 -.34:68 .52 .12 -.08:.32 .24
Negative life
events
1.11 .80:1.42
R²:073
.000 .33 .04:.63
R²:015
.02 .15 .03:.27
R²:021
.01
Chronic
problems
.18 -.54:.91 .61 -.11 -.81:.58 .74 .02 -.25:.30 .84
Depressive
symptoms
.20 .18:.23 .000 .12 .09:.14 .000 .07 .06:.08 .000
R² values for the
full models
.225*
.094*
.165*
Cosmina Zolog et al.
120
of anxiety symptoms: separation anxiety
symptoms, generalized anxiety symptoms,
social phobia symptoms and total
SCARED score. These findings fit in well
with other studies that employed the same
instrument with preadolescents and early
adolescents (e.g., Arratíbel–Siles et al.,
2010; Essau et al., 2002; Muris et al.2002).
Some studies have intended to find psy-
chological factors associated with the de-
velopment of anxiety. The results de-
monstrated that girls have more difficulty
than boys with certain psychological fac-
tors, for instance, girls are over concerned
about their social competence (Kashani,
Orvaschel, Rosenberg & Reid, 1989) and
place higher importance on interpersonal
relationships (Maccoby, 1990) to a greater
extent than boys, so it is not surprising that
girls report higher levels of social anxiety
symptoms. In any case, more studies are
needed in order to understand the sequen-
cing of the anxiety and associated psycho-
logical factors.
Other studies have examined the genetic
predispositions that may also make preado-
lescent and adolescent girls more suscepti-
ble to anxiety development. Indeed, there is
evidence of genetic contributions to separa-
tion anxiety symptoms being higher for
girls than boys. In the Virginia twin study
(Simonoff et al., 1997), genetic influences
accounted for about 75% of the variance of
separation anxiety symptoms in girls,
whereas for boys the heritability estimate
was close to zero. Silove, Manicavasagar,
O'Connell, and Morris-Yates (1995)
offered an evolutionary explanation for this
gender difference, claiming that it may
originate with a survival mechanism deve-
loped at some point in our history: to fear
separation is more adaptive for females be-
cause in staying close to home they pro-
moted close family relationships ideal for
child rearing.
A growing body of evidence suggests
that gender differences in anxiety are po-
ssibly due to the implications of the gender
role hypothesis (e.g., Ollendick, Yang,
Dong, Xia & Lin, 1995). The explanation
given is that girls and boys are socialized to
develop gender-or sex-typed feminine and
masculine behaviors, traits, and skills.
Therefore, expressing fearfulness is more
consistent with the feminine gender role
and is tolerated, accepted or encouraged in
girls (e.g. Bem, 1981; Golombok & Fivush,
1994) but not in boys. Of course, these
speculations are in need of more systematic
investigation.
Additional analyses were effectuated in
order to show whether the outcomes re-
garding the associations between age, gen-
der and various type of anxiety symptoms
are similar after controlling for the effects
of all types of anxiety symptoms. In this
Table 3. Associations between negative life events and depressive symptoms
Depressive symptoms
B CI 95% p
Negative life events 1.20 .66:1.73
R²:058
.000
Gender -.62 -1.14:-.10 .01
Age .20 -.06:.47 .13
General anxiety .31 .28:.33 .000
Socio-economic status 2.67 1.69:3.66 .000
Chronic problems -.49 -1.76:.76 .44
R² values for the full model .344*
Age, gender and negative life events in anxiety and depression at pre- and early adolescence
121
regard, we introduced in each regression
model the different types of anxiety symp-
toms as predictor variables. The association
between gender and generalized anxiety
symptoms was not significantly maintained
after controlling for the effects of social
and separation anxiety symptoms, panic
symptoms and school avoidance symp-
toms. Likewise, the association between
gender and separation anxiety symptoms
was not significantly maintained after con-
trolling for the effects of social and gene-
ralized anxiety symptoms, panic symptoms
and school avoidance symptoms.
With regard to age and anxiety symp-
toms, we found that younger children were
more likely to report higher levels of ge-
neral anxiety, separation anxiety symptoms
and panic symptoms than older children. In
the same line, Muris et al. (2002) found
small significant negative associations
between age and all factors of the
SCARED.
In our study the negative association
between panic and age is similar to that
found in other studies that used the same
age range and self-report method (Mellon
& Moutavelis, 2007; Muris et al., 2002;
Spence, 1998), and there are no reasonable
explanations for these findings. It is unclear
what this age difference means, and further
research is needed to clarify whether this
means difficulty among younger children
in comprehending the questions or whether
it is a real effect of symptom prevalence.
Some evidence from the literature supports
the idea that younger children tend to ex-
cessively report symptoms. In this regard,
Wren, Bridge, and Birmaher (2004), who
used a sample of preadolescents and early
adolescents (8 to 12 years old) in primary
care and the SCARED as a self report, con-
cluded that child age and female gender
were significant independent predictors of
excessive symptom reporting in children.
Further investigations are warranted to
clarify these important aspects of panic in
children.
We did not find significant relationships
between age and social anxiety symptoms
and school phobia symptoms even though
there are studies which have found unusual
patterns for social phobia symptoms
(Muris, Merckelbach, Schmidt & Mayer,
1999; Muris et al., 2000; Spence, 1998),
with a tendency for younger children to re-
port higher scores of social anxiety symp-
toms; meanwhile others report significant
positive relationships (Chorpita et al.,
2000; Linyan et al., 2007; Weems & Costa,
2005). Further research is needed in order
to clarify certain aspects regarding the rela-
tionship between age and social anxiety
symptoms.
Regarding the age and gender diffe-
rences in Spanish samples of children and
adolescents, our results are similar to the
findings by García-Villamisar, Vidal and
Yenes (2002), with girls scoring higher
than boys on social phobia scale or with
negative associations between age and
separation anxiety symptoms. Along the
same line, Olivares et al. (2006) found
more girls suffering from social phobia and
but no significant association between age
and social phobia.
With regard to the second objective of
the present study, we found that negative
life events were significantly associated
with both general anxiety and depression
symptoms.
Negative life events were significantly
associated with all types of anxiety symp-
toms. These findings are comparable to the
findings by Pedreira (1998) or Brown and
Harris (1989). But despite the studies that
found negative life events more associated
with depressive than anxiety disorders (see
Williamson, Birmaher, Dahl & Ryan,
1999), in our study, negative life events are
more associated with general anxiety
symptoms than with depressive symptoms.
Cosmina Zolog et al.
122
Also, we found negative life events signifi-
cantly more associated with generalized
anxiety symptoms than others types of
anxiety symptoms.
There were a few limitations to our stu-
dy that call for caution in interpreting our
findings: the study relied exclusively on the
children's self-reports. Furthermore, no
diagnostic interview was used; in our
study, symptoms were used to identify the
various types of anxiety disorders. Only 8-
13 year olds were included in our study, so
our findings cannot be generalized to other
populations (e.g., adolescents).
Acknowledgments
This research was supported by grants
from the Instituto de Salud Carlos III, Min-
isterio de Sanidad y Consumo (PI 07/0839
and PI 04/0978).
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... Firstly, because the age range in our samples is quite large for a developing population (at least in sample 1 and 2) studies with a closer age range could be used to further pinpoint developmental critical age ranges for the associations found. Secondly, the incidence and prevalence of anxiety disorders as well as reported anxiety measures seems to be a different between male and female subjects (Stewart, Taylor, & Baker, 1997;Zolog, Bonillo, Ballabriga, & Canals, 2011). A priori we could not find sex differences between phenotypes, nonetheless anxiety disorders have a higher prevalence in women (World Health Organization, 2004a). ...
Thesis
Full-text available
Anxiety disorders are the most prevalent group of neuropsychiatric disorders and go along with high personal suffering. They often arise during childhood and show a progression across the life span, thus making this age a specific vulnerable period during development. Still most research about these disorders is done in adults. In light of this, it seems of utmost importance to identify predictive factors of anxiety disorders in children and adolescents. Temperament or personality traits have been proclaimed as risk markers for the development of subsequent anxiety disorders, but their exact interplay is not clear. In this dissertation an effort is made to contribute to the understanding of how risk markers of early temperamental traits, in this case Trait Anxiety, Anxiety Sensitivity and Separation Anxiety are interplaying. While Trait Anxiety is regarded as a more general tendency to react anxiously to threatening situations or stimuli (Unnewehr, Joormann, Schneider, & Margraf, 1992), Anxiety Sensitivity is the tendency to react with fear to one’s own anxious sensations (Allan et al., 2014; S. Reiss, Peterson, Gursky, & McNally, 1986), and Separation Anxiety is referring to the extent to which the child is avoiding certain situations because of the fear of being separated from primary care givers (In-Albon & Schneider, 2011). In addition, it will be addressed how these measurements are associated with negative life events, as well as brain functioning and if they are malleable by a prevention program in children and adolescents. In study 1 the aim was to extend the knowledge about the interrelations of this anxiety dimensions and negative life events. Results indicated positive correlations of all three anxiety traits as well as with negative life events. Thus, a close connection of all three anxiety measures as well as with negative life events could be indicated. The closest association was found between Anxiety Sensitivity and Trait Anxiety and between Separation Anxiety and Anxiety Sensitivity. Furthermore, negative life events functioned as mediator between Anxiety Sensitivity and Trait Anxiety, indicating that a part of the association was explained by negative life events. In study 2 we extended the findings from study 1 with neurobiological parameters and examined the influence of anxiety traits on emotional brain activation by administering the “emotional face matching task”. This task activated bilateral prefrontal regions as well as both hippocampi and the right amygdala. Further analyses indicated dimension-specific brain activations: Trait Anxiety was associated with a hyperactivation of the left inferior frontal gyrus (IFG) and Separation Anxiety with a lower activation bilaterally in the IFG and the right middle frontal gyrus (MFG). Furthermore, the association between Separation Anxiety and Anxiety Sensitivity was moderated by bi-hemispheric Separation-Anxiety-related IFG activation. Thus, we could identify distinct brain activation patterns for the anxiety dimensions (Trait Anxiety and Separation Anxiety) and their associations (Separation Anxiety and Anxiety Sensitivity). The aim of study 3 was to probe the selective malleability of the anxiety dimensions via a prevention program in an at-risk population. We could identify a reduction of all three anxiety traits from pre- to post-prevention-assessment and that this effect was significant in Anxiety Sensitivity and Trait Anxiety scores. Furthermore, we found that pre-intervention Separation Anxiety and Anxiety Sensitivity post-intervention were associated. In addition, pre-interventive scores were correlated with the intervention-induced change within the measure (i.e., the higher the score before the intervention the higher the prevention-induced change) and pre-intervention Anxiety Sensitivity correlated with the change in Separation Anxiety scores. All relations, seemed to be direct, as mediation/moderation analyses with negative life events did not reveal any significant effect. These results are very promising, because research about anxiety prevention in children and adolescents is still rare and our results are indicating that cognitive-behavioural-therapy based prevention is gilding significant results in an indicated sample even when samples sizes are small like in our study. In sum the present findings hint towards distinct mechanisms underlying the three different anxiety dimensions on a phenomenological and neurobiological level, though they are highly overlapping (Higa-McMillan, Francis, Rith-Najarian, & Chorpita, 2016; Taylor, 1998). Furthermore, the closest associations were found between Anxiety Sensitivity and Trait Anxiety, as well as between Separation Anxiety and Anxiety Sensitivity. Specifically, we were able to find a neuronal manifestation of the association between Separation Anxiety and Anxiety Sensitivity (Separation Anxiety-specific IFG activation) and a predictive potential on prevention influence. The results of these studies lead to a better understanding of the etiology of anxiety disorders and the interplay between different anxiety-related temperamental traits and could lead to further valuable knowledge about the intervention as well as further prevention strategies.
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To document prevalence and associations of somatic symptoms in Spanish preschool children. Subjects were 3- to 5-year-olds attending nurseries (8 urban, 30 rural). Parental questionnaires (response rate 77%) were used to inquire about somatic symptoms in the child in the 2 weeks prior to assessment, about preschool absence and pediatric help-seeking, chronic family health problems, and recent stressful life events for the child. Parents completed questionnaires on child psychopathology (Early Childhood Inventory 4) and their own mental health (General Health Questionnaire). Children who were reported as complaining of symptoms frequently (four or more times) were compared to noncomplaining children. Parents reported that 452 of the 807 (56%) children complained of somatic symptoms at least once, significantly more so in urban than in rural areas. Frequent somatic complaints were reported for 165 of the 807 (20%) (abdominal pains 7.9%, tiredness 5.7%, leg pains 4%, headaches 2%, dizziness 0.4%). There were significant associations of frequent symptom reporting with days off preschool and pediatric clinic attendance, with emotional and behavioral symptoms in children, mental distress in parents, and urban abode. Somatic symptoms are common in preschool children. Results point to family influences.
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Parents' concerns typically determine the focus of a primary care visit. This study examined which information is lost if child reports are excluded from screening for anxiety. It also explores the use in primary care of the Screen for Child Anxiety Related Emotional Disorders (SCARED) and the Pediatric Symptom Checklist (PSC-17). Two hundred thirty-six children (8-12 years 11 months) and their parents completed SCARED and PSC-17 before a primary care visit occurring during discrete periods between June 1999 and March 2001. Child reports yielded higher SCARED scores than parent reports (mean=18.12, SD=12.14 versus 14.43, SD=10.34, p <.001). Somatic/panic and separation anxiety accounted for 73.8% of the excess score from children's reports. The level of parent-reported symptoms did not vary with demographics. Female gender and younger age predicted greater excess reporting by children. Parent and child scores were moderately to highly correlated (R=0.55 total score; 0.40-0.58 subfactors). There are discrete anxiety domains in which children's reports are likely to yield more information than that of parents. This phenomenon is almost entirely attributable to variations in the level of symptoms reported by children. Studies are needed to design brief screening procedures that integrate parent and child reports and carry age- and gender-adjusted thresholds.