Familial correlates of anxiety and depression in high-risk offspring.

摘要

Anxiety and depressive disorders are among the most common psychiatric disorders in the U.S. adult population. With respect to children, high rates of anxiety or worries have been observed across international samples, while a sharp increase in the risk of depression has been consistently observed at puberty. The observed familial aggregation of both anxiety and depressive disorders may be a function of environmental as well as genetic risk factors shared by family members. Evidence of the involvement of family environment has been gathered from both family-genetic and non-genetic studies, although rarely with a systematic approach which integrates both types of risk factors. The goal of this thesis was to comprehensively examine both the direct and indirect parental and familial mechanisms associated with anxiety and depression (internalizing disorders) using data from the Yale Family Study of comorbidity of substance and anxiety disorders. These analyses confirm and extend previous findings on the association between family environment and offspring internalizing disorders. Both maternal and paternal parenting style were associated with offspring internalizing disorders. With respect to parental marital discord, a troubled marital relationship between parents was related to offspring depression. Unhealthy family functioning was associated with all offspring internalizing diagnoses, while low family cohesion was specifically associated with offspring depression. A two-step analytic procedure was followed in order to simultaneously model the association of parental psychopathology, perceived family measures and demographic factors with offspring internalizing disorders. First, classification trees were created based on the self-reported family measures and second the terminal nodes from the classification trees were used to create "dummy variables" for the generalized logit models from which risk estimates were produced. When multi-factor family environment profiles and parental psychopathology were examined simultaneously, family environment was highly significantly associated with anxiety in offspring under age 12 and with depression (with or without anxiety) in older offspring. Family environment must be examined longitudinally within the context of high-risk studies in order to fully explore the directionality of these associations and to ultimately expose the mechanisms underlying the familial aggregation of anxiety and depression.