Anxiety Disorders Across Childhood and Adolescence in a U.K Population-Based Cohort

Abstract

Background: Patterns of development and underlying factors explaining anxiety disorders in children and adolescents have been an under-researched area, despite their high prevalence, impact on social and educational functioning and associations with other mental disorders. We aimed to characterize the development of anxiety disorders, to understand the underlying trajectories of each of the anxiety disorders, and to examine the possible socio-demographic and health-related predictors of persistent anxiety disorders, across childhood and adolescence using data from a large birth cohort. Methods: This cohort study assessed 13988 participants in the ALSPAC birth cohort. The Development and Wellbeing Assessment (DAWBA) questionnaire was administered to parents to capture child and adolescent anxiety total scores and anxiety diagnoses. The following anxiety disorders at 8, 10 and 13 years were selected: separation anxiety, specific phobia, social anxiety, acute stress reaction, and generalized anxiety. Further, we included the following socio-demographic and health-related factors: sex, birth weight, sleep difficulties at 3.5 years, ethnicity, family adversity, maternal age at birth, maternal postnatal anxiety, maternal postnatal depression, maternal bonding, maternal socio-economic status and maternal education. Descriptive analyses for anxiety diagnoses and symptomatology, group trajectories of each of the anxiety disorders using latent class growth analysis, and associations with socio-demographic and health-related factors were quantified. Outcomes: Different anxiety disorders presented different prevalence and patterns of development over time. Further, latent class growth analyses yielded a trajectory characterized by individuals with persistent high levels of anxiety across childhood and adolescence, for specific phobia, social anxiety, acute stress reaction and generalized anxiety. Finally, different risk factors were specifically and significantly associated with each of the persistent high levels of anxiety disorders, with child sleeping difficulties and postnatal maternal depression and anxiety being the most important. Interpretation: Ours findings show that despite trends of general improvement in most individuals with anxiety disorders, a small group of children and adolescents continue to suffer from frequent and severe anxiety. Further, when considering treatment strategies for anxiety disorders in children and adolescents, children’s sleep difficulties and postnatal maternal depression and anxiety need to be assessed as these may predict a more prolonged and severe course of illness. Funding: This study was supported by the UK Medical Research Council and Wellcome Trust. Declaration of Interest: We declare no competing interests. Ethical Approval: Ethical approval was obtained from the ALSPAC Law and Ethics Committee and local research ethics committees. Informed consent was obtained from participants following the recommendations of the ALSPAC Ethics and Law Committee at the time.