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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    • "Anxiety-related disorders are the most prevalent mental illnesses [Kessler et al., 2005a, 2005b], and high trait anxiety is associated with increased risk for numerous mental disorders, including depression and bipolar disorder [Bruckl et al., 2007; Reinherz et al., 2000]. Neurocognitive models of anxiety highlight the importance of the amygdala [Davis, 1992; Rauch et al., 2003], and interactions with regions important for cognitive control, as well as emotion generation, regulation, and perception [Bishop, 2007; Milad and Quirk, 2012]. "
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    ABSTRACT: In this study we demonstrate that the pattern of an amygdala-centric network contributes to individual differences in trait anxiety. Individual differences in trait anxiety were predicted using maximum likelihood estimates of amygdala structural connectivity to multiple brain targets derived from diffusion-tensor imaging (DTI) and probabilistic tractography on 72 participants. The prediction was performed using a stratified sixfold cross validation procedure using a regularized least square regression model. The analysis revealed a reliable network of regions predicting individual differences in trait anxiety. Higher trait anxiety was associated with stronger connections between the amygdala and dorsal anterior cingulate cortex, an area implicated in the generation of emotional reactions, and inferior temporal gyrus and paracentral lobule, areas associated with perceptual and sensory processing. In contrast, higher trait anxiety was associated with weaker connections between amygdala and regions implicated in extinction learning such as medial orbitofrontal cortex, and memory encoding and environmental context recognition, including posterior cingulate cortex and parahippocampal gyrus. Thus, trait anxiety is not only associated with reduced amygdala connectivity with prefrontal areas associated with emotion modulation, but also enhanced connectivity with sensory areas. This work provides novel anatomical insight into potential mechanisms behind information processing biases observed in disorders of emotion. Hum Brain Mapp, 2015. © 2015 Wiley Periodicals, Inc.
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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.
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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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