Parental Psychopathology Research Articles

Parental depressive symptoms and child psychopathology: Effects of parenting‐specific emotion regulation and emotion socialization

AbstractObjectiveThe study explores the associations among parental depressive symptoms, child symptoms of psychopathology, emotion socialization (ES), and parenting‐specific emotion regulation (ER) using a novel measure, the Regulating Emotions in Parenting Scale (REPS).BackgroundThere is a notable correlation between parental depressive symptoms and symptoms of psychopathology in children. Empirical studies have also observed a correlation in the intergenerational patterns of ER, as well as their relations to ES. Investigating these relations in nonclinical samples is vital for understanding these risk factors and how they relate to child mental health.MethodThe study sample was comprised of n = 315 mothers and fathers and used a cross‐sectional design. Assessments were conducted on parental depressive symptoms, child psychopathology, ES, and parenting‐specific ER (REPS).ResultsOur findings revealed that parental depressive symptoms were significantly associated with all ER strategies in the parenting context. These ER strategies, in turn, were related to unsupportive ES practices, which were further related to child psychopathology. Parenting‐specific ER strategies and parents' supportive ES had a significant indirect effect on the association between parental depressive symptoms and child psychopathology. However, only indirect effects through unsupportive ES and suppression and rumination were significant, not adaptive ER.ConclusionsThe study's cross‐sectional correlations provide support for the role of parenting‐specific ER as it relates to ES, parental, and child psychopathology.ImplicationsFindings imply that how parents regulate their emotions during parenting significantly affects their ability to engage in supportive ES practices, but replication in a longitudinal framework is warranted.

Associations between parental psychopathology and youth functional emotion regulation brain networks

Parental mental health is associated with children’s emotion regulation (ER) and risk for psychopathology. The relationship between parental psychopathology and children’s functional ER networks and whether connectivity patterns mediate the relationship between parent and youth psychopathology remains unexplored. Using resting-state functional magnetic resonance imaging data from the Adolescent Brain Cognitive Development Study (N = 4202, mean age = 10.0) and a multilevel approach, we analyzed the relationship between self-reported parental psychopathology and their offsprings’ connectivity of four ER networks, as well as associations with self-reported youth psychopathology at a 3-year follow-up. Parental internalizing and total problems were associated with 1) higher connectivity between a subcortical-cortical integrative and ventrolateral prefrontal cortical (PFC) network, 2) lower connectivity between dorsolateral and ventrolateral PFC networks involved in cognitive aspects of ER, and 3) lower connectivity within a subcortical ER network (β = -0.05-0.04). Parental externalizing and total problems were associated with lower connectivity within the integrative network (βext = -0.05; βtot = -0.04). Mediation analyses yielded direct effects of parental to youth psychopathology, but no mediation effect of ER network connectivity. Overall, our results show that ER network connectivity in youth is related to parental psychopathology, yet do not explain intergenerational transmission of psychopathology.

Lability in parent-child warmth and hostility and adolescent externalizing behaviors.

Both longer term developmental changes (increases in hostility, decreases in warmth) and lability (year-to-year fluctuations) in parent-child relationship quality across childhood and adolescence have been linked to adolescent externalizing behaviors. Using a prospective longitudinal study of 561 children who were adopted into nonrelative families at birth (57% male, 56% White, 19% multiracial, 13% Black, 11% Hispanic) where parental warmth and hostility reflect environmental influences or child-evoked reactions, we examined associations between parent-child relationship measures and externalizing behaviors at age 11 and across adolescence (i.e., from age 11 to 13-15 years). Because studies considering gene-environment interplay especially in associations between lability and child externalizing behaviors are sparse and parent-child relationship measures support the intergenerational transmission of psychopathology, we also tested whether parent psychopathology of both adoptive parent (AP; environmental intergenerational transmission) and birth parents (genetic intergenerational transmission) moderated these associations in multivariate regression models. Findings generally supported more effects of fathers' than mothers' warmth and hostility. Although there were some linear associations of increased lability with externalizing behaviors, these did not persist in the context of a multivariate model. Associations between both parents' increasing hostility across childhood on age 11 externalizing behaviors and for fathers increasing hostility and decreasing warmth on increases in externalizing behaviors across adolescence more likely reflect a combination of bidirectional evocative and parenting environmental associations than purely parenting environmental transmission. Moderation by parent psychopathology was sparse, and sensitivity tests revealed no differences by child sex. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Complex emotion processing and early life adversity in the Healthy Brain Network sample

ObjectiveEarly life adversity (ELA) has shown to have negative impacts on mental health. One possible mechanism is through alterations in neural emotion processing. We sought to characterize how multiple indices of ELA were related to naturalistic neural socio-emotional processing. MethodIn 521 5–15-year-old participants from the Healthy Brain Network Biobank, we identified scenes that elicited activation of the Default Mode Network (DMN), Ventral Attention Network (VAN), Cingulo-Opercular Network (CON) and amygdala, all of which are networks shown to be associated with ELA. We used linear regression to examine associations between activation and ELA: negative parenting, social status, financial insecurity, neighborhood disadvantage, negative experiences, and parent psychopathology. ResultsWe found DMN, VAN, CON and amygdala activation during sad/emotional, bonding, action, conflict, sad, or fearful scenes. Greater inconsistent discipline was associated with greater VAN activation during sad or emotional scenes. ConclusionFindings suggest that the DMN, VAN, CON networks and the amygdala support socio-emotional processing consistent with prior literature. Individuals who experienced inconsistent discipline may have greater sensitivity to parent–child separation signals. Since no other ELA–activation associations were found, it is possible that unpredictability may be more strongly associated with complex neural emotion processing than socio-economic status or negative life events.

It takes three: Parental hostility, brain morphology and child externalizing problems in a parent-offspring neuroimaging trio design.

Hostility often co-occurs in parents and associates with increased aggression and inattention problems in children. In this population-based cohort of 484 mother-father-child neuroimaging trios, we investigated the degree to which associations of prenatal and childhood parental hostility would be associated with maternal, paternal and child brain structural differences. Also, we examined whether hippocampal volumes of the parents or child mediate the association of prenatal parental hostility with child externalizing behaviors. Maternal and paternal hostility was assessed with the hostility subscale of the Brief-Symptom-Inventory at three time points: prenatally at 30 weeks gestation, and when the child was 3 and 10 years old. During adolescence assessment wave (age 14), maternal, paternal, and offspring assessment included a magnetic-resonance-imaging (MRI). Child externalizing problems were assessed with Youth-Self-Report-Child-Behavior-Checklist.Our findings suggest that maternal and paternal hostility were each associated with smaller gray matter, white matter, and hippocampal volumes of their own and their partner's brain. Prenatal maternal but not paternal hostility was associated with smaller total gray matter, white matter, and hippocampal volumes in the offspring. The child's hippocampal volumes partially mediated the associations of prenatal parental hostility (latent-construct) with adolescent externalizing behavior, even after adjusting for prior child externalizing problems. Moreover, parental psychopathology may have long-lasting neurodevelopmental correlates in children that underlie the intergenerational transmission of behavioral problems. The behavior of family members results from a system of interdependent dyadic relationships over time that associate with specific brain structural differences.Significance statement Parental hostility often co-occurs in the parents. Research suggests that what transpires in one family subsystem, e.g. hostility among parents, is related to what transpires in other subsystems, e.g. mother-child or father-child, and can negatively impact child development. To understand the neurobiological effects of parental hostility on the families, these can best be studied with trio analysis as parents and children may all be affected. Overall, the findings elucidate how hostility of a parent negatively relates to different family subsystems and associated brain characteristic, such as the hippocampal volume. Our findings suggest that the behavior of family members results from a system of interdependent dyadic relationships over time that associate with specific brain structural differences.

Patterns of early childhood adversity and neighborhood deprivation predict unique challenges in adolescence: A UK birth cohort study.

This study applies a comprehensive bioecological perspective to address a significant gap in the childhood adversity literature by employing latent profile analysis to examine the impact of diverse combinations of early childhood adversities and protective factors on adolescent psychosocial and behavioral outcomes. Drawing from the United Kingdom's Millennium Cohort Study (N = 19,444), we identified eight unique profiles of early childhood adversity and protective factors. These profiles provide a nuanced understanding of adversity combinations and allow for differentiation between groups with similar profiles. Latent profile membership was a significant predictor of all adolescent outcome variables, indicating that profiles differed significantly from one another on psychosocial and behavioral outcomes (Wald values ranged from 10.10-623.22; p < .001). Some findings support the cumulative risk model, indicating that exposure to multiple early adversities increases the likelihood of adverse outcomes. However, we also found that specific adversities, such as parental psychopathology, parental alcohol use, and neighborhood deprivation, uniquely impact adolescent outcomes. This study highlights the necessity for tailored interventions and policies to support children with distinct early life experiences, emphasizing the importance of addressing both cumulative and specific adversities at multiple levels to prevent psychosocial and behavioral problems in adolescence.

Parental Depression Symptoms, Skin Conductance Level Reactivity and Parenting: Associations with Youth Psychopathology.

Parental depression symptoms are a prevalent risk factor for internalizing and externalizing problems in youth, with parenting and parents' physiological stress reactivity representing potential contributing factors in the intergenerational transmission of psychopathology symptoms. In a sample of adolescents (N = 97) and their parents, the current study examined parental depression symptoms, an observational measure of parenting, and parents' physiological reactivity during a dyadic conflict discussion task in association with adolescents' internalizing and externalizing psychopathology. Parental depression symptoms and harsh/insensitive parenting showed positive associations with youth psychopathology symptoms. Further, parental depression symptoms were associated with greater externalizing symptoms in youth, specifically for parents with higher physiological reactivity during the conflict task. The present study highlights risks associated with parental depression and harsh/insensitive parenting, and provides evidence for parental physiological reactivity as a moderator of the association between parent and youth psychopathology. Clinical implications, limitations, and directions for future research are discussed.

Intergenerational transmission of comorbid internalizing and externalizing psychopathology at age 11: Evidence from an adoption design for general transmission of comorbidity rather than homotypic transmission.

Psychopathology is intergenerationally transmitted through both genetic and environmental mechanisms via heterotypic (cross-domain), homotypic (domain-specific), and general (e.g., "p-factor") pathways. The current study leveraged an adopted-at-birth design, the Early Growth and Development Study (57% male; 55.6% White, 19.3% Multiracial, 13% Black/African American, 10.9% Hispanic/Latine) to explore the relative influence of these pathways via associations between adoptive caregiver psychopathology (indexing potential environmental transmission) and birth parent psychopathology (indexing genetic transmission) with adolescent internalizing and externalizing symptoms. We included composite measures of adoptive and birth parent internalizing, externalizing, and substance use domains, and a general "p-factor." Age 11 adolescent internalizing and externalizing symptom scores were the average of adoptive parent reports on the Child Behavior Checklist (n = 407). Examining domains independently without addressing comorbidity can lead to incorrect interpretations of transmission mode. Therefore, we also examined symptom severity (like the "p-factor") and an orthogonal symptom directionality score to more cleanly disentangle transmission modes. The pattern of correlations was consistent with mostly general transmission in families with youth showing comorbid internalizing and externalizing symptoms, rather than homotypic transmission. Findings more strongly supported potential environmental or evocative mechanisms of intergenerational transmission than genetic transmission mechanisms (though see limitations). Parent-specific effects are discussed.

Prediction of suicide attempt in a Swedish population-based cohort.

Suicidal behaviors are prevalent public health concerns, and we need to improve our predictive ability to better inform prevention efforts. Using nationwide longitudinal Swedish registers, we included 344,490 males and 323,177 females born 1982-1990 with information on genetic liability and environmental exposures from birth to age 16: perinatal variables, parental psychopathology (suicide attempt, substance use disorder, major depression), family status, socioeconomic difficulties, peers' psychopathology, and school grades. We conducted sex-specific analysis and developed data-driven predictive models including risk factors that occurred between ages 0 and 16 using structural equation modeling. In both females and males, the best-fitting models reveal a complex risk pathway to suicide attempt. In females, the model indicates four direct effects on suicide attempt risk: the occurrence of suicide attempt in parents during childhood (β = 0.159, 95% CI: 0.118; 0.199) and adolescence (β = 0.115, 95% CI: 0.077; 0.153), suicide attempt in peers (β = 0.068, 95% CI: 0.057; 0.079), and low academic achievement (β = 0.166, 95% CI: 0.156; 0.175). In males, aggregate genetic liability for suicide attempt (β = 0.130, 95% CI: 0.111; 0.148), suicide attempt in parents during adolescence (β = 0.099, 95% CI: 0.074; 0.124), suicide attempt in peers (β = 0.118, 95% CI: 0.108; 0.129), and low academic achievement (β = 0.61, 95% CI: 0.152; 0.171) were related to later suicide attempt. These factors also acted as mediators to explain the association between environmental exposures in childhood and later suicide attempt. These findings illustrate sex-specific pathways to suicide attempt by including risk factors that occur during the development. Results highlight the importance of genetic and family environment but also the prominent role of academic achievement.

Improve Mental Health (Improve-MH) in refugee families using a culturally adapted, general practitioner-delivered psychotherapeutic intervention combined with Triple P Online parenting programme: study protocol of a multicentre randomised controlled trial

IntroductionGermany and the European Union have experienced successive waves of refugees since 2014, resulting in over 1.6 million arrivals, including families with young children. These vulnerable populations often face xenophobia,...

Parental psychopathology and offspring anxiety disorders in childhood and adolescence: A Finnish nationwide register study

BackgroundResearch suggests an association between parental psychiatric disorders and offspring anxiety disorders, yet comprehensive studies are limited. This study aims to investigate the associations between various parental psychiatric disorders and anxiety disorders in their offspring. MethodUsing Finnish register data, this nested case-control study analyzed 867,175 singleton live births from 1992 to 2006, identifying 21,671 cases of anxiety disorders diagnosed between 1998 and 2016. Matched with four controls each (n = 72,414) based on age and biological sex, the study adjusted for demographic and prenatal factors using conditional logistic regression models to calculate odds ratios (aORs). ResultsThere was a significant association between parental psychiatric disorders and increased risk of anxiety disorders in offspring. The risk was notably higher when both parents had psychiatric disorders (aOR = 5.04; 95 % CI, 4.70‐5.39; p < .001). Maternal psychiatric disorders were strongly associated with offspring anxiety than paternal disorders (aOR 1.52; 95 % CI 1.43–1.61; p < .001). This association was consistent regardless of timing of parental diagnosis. Significant associations were observed between any parental psychiatric disorder and increased risks in offspring for specific phobia, social phobia, generalized anxiety disorder, separation anxiety, and panic disorder. Maternal psychiatric disorders showed elevated risk for panic disorder and social phobia among girls and separation anxiety and generalized anxiety among boys. ConclusionThe findings emphasize the significant impact of parental psychiatric health on offspring anxiety disorders, highlighting the influence of genetic and environmental factors. Addressing parental mental health is crucial in preventing childhood anxiety disorders.

Risk and protective factors associated with health-related quality of life in children and adolescents with ADHD in Germany - Findings from the consortium project INTEGRATE-ADHD.

The health-related quality of life (HRQoL) of individuals living with Attention-deficit/hyperactivity disorder (ADHD) is known to be impaired. Identifying factors that influence HRQoL can provide important information for the development of prevention and intervention programmes for affected children and adolescents. The aim of the present study was to investigate health care-related and psychosocial risk and protective factors for HRQoL in children and adolescents with an administrative ADHD diagnosis. In the consortium project INTEGRATE-ADHD, n = 4,809 parents of children and adolescents aged 7 to 17 years participated in an online survey between October 2021 and August 2022 and answered questions regarding HRQoL (KIDSCREEN-27), health care utilisation, and psychosocial risk and protective factors. Multiple linear regression analyses were conducted to assess the association between these factors and the five HRQoL dimensions of the KIDSCREEN-27. Findings indicate that parental psychopathology and parental burden were risk factors for lower HRQoL in children and adolescents with ADHD. Further, a positive association was found between the five HRQoL dimensions and the psychosocial factors family climate and social support, indicating that these are protective factors. The results highlight the importance of prevention and intervention programmes for individuals with ADHD that consider parental mental health and aim to strengthen resources such as the availability of good family climate and social support.

Symptom network analysis of parent-child depression and anxiety in treatment-seeking youth.

Youth of parents who are experiencing psychopathology are more likely to develop emotional concerns, and these mental health symptoms can have a deleterious impact on parents' mental health. However, the relationship between the presentation of specific symptoms in parents and youth is infrequently examined. Symptom network analysis is an analytic approach that is increasingly being used to better understand the relationship of symptoms within and between disorders and can also be used to examine symptom relations within a dyad. The present study used symptom network analysis to examine bidirectional relationships among depressive and anxiety psychopathology in a transdiagnostic sample of treatment-seeking youth and their primary caregiver. Parental anhedonia and child worthlessness exhibited the greatest centrality within the network, suggesting that these may act as risk and maintenance factors for parent-child psychopathology and may be important intervention targets. Findings support the use of symptom network analysis to inform an understanding of the complex relationships among parent and child depressive and anxiety symptoms. Future research should consider the use of network analytic methods to examine the temporal relationships between parent and child psychopathology and to inform joint parent-child interventions for those with internalizing concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Self-esteem mediates child abuse predicting adulthood anxiety, depression, and substance use symptoms 18 years later

According to biopsychosocial models, experiencing parental child abuse increases susceptibility to adulthood psychopathology. However, there is a paucity of studies examining potential mechanisms of the parental child abuse and adulthood psychopathology relationship. The purpose of the current study was to determine if Time 2 (T2) trait self-esteem mediated levels of Time 1 (T1) retrospectively recalled parental child abuse predicting (T3) past-year major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD), alcohol use disorder (AUD), and substance use disorder (SUD) symptoms. The 18-year Midlife Development in the United States (MIDUS) study included participants (N = 3294; T1 average age of 45.62 years) assessed at three different time points, each spaced about nine years apart. We performed structural equation mediation modeling analyses to determine how maternal and paternal child abuse at T1 would independently predict T3 MDD, GAD, PD, AUD, and SUD symptoms. We also examined whether T2 self-esteem mediated these relations while controlling for adulthood T1 psychopathology symptoms, demographics, socioeconomic status, somatic symptoms, and parental psychopathology. Consistent with our hypotheses, higher T1 maternal and paternal abuse predicted increased T3 GAD, PD, AUD, and SUD symptoms via diminished T2 self-esteem as the mediator (% proportion mediated = 33.0–100). However, childhood paternal, but not maternal, abuse predicted adulthood MDD symptoms via reduced self-esteem. Findings remained after adjusting for covariates. Our research highlights the importance of understanding retrospectively recalled parental child abuse–adulthood psychopathology relations, their potential mechanisms, and self-esteem as a malleable treatment target for adults with heightened child abuse.

Intergenerational transmission of psychopathology across three generations: the role of social support.

Psychopathology runs in families and affects functioning of individuals and their family members. This study assessed the intergenerational transmission of psychopathology risk across three generations, and the extent to which social support factors may protect against this transmission from parents to their offspring. This study was embedded in Generation R, a multi-ethnic population-based cohort from fetal life onwards. Lifetime psychiatric disorders of grandparents were assessed with the Family Informant Schedule Criteria- updated for DSM-IV. Parental psychopathology was repeatedly measured by the Brief Symptom Inventory. Offspring psychopathology (ages 10 and 14) was assessed with the Brief Problem Monitor. Maternal and child social factors were assessed using questionnaire measures and a computerized peer nomination assessment. Our results show that the estimated additive interaction effect for the risk transmission of grandparental and pre- and postnatal parental psychopathology to offspring psychopathology was 23% (95% CI 19; 27). The joint effect of grandparental and parental psychopathology combined with maternal and child social support factors was 13% (95% CI 08; 17)], suggesting that social support factors diminished the intergenerational transmission of psychopathology from (grand)parents (G1 and G2) to offspring (G3). Transmission of psychopathology risk may have long-lasting developmental effects across generations. Social support factors reduced the vulnerability to the effects of psychopathology risk, underscoring the importance of the identification of buffering factors associated with good mental health in adolescents who are at high familial risk.

Transgenerational transmission of psychopathology: when are adaptive emotion regulation strategies protective in children?

BackgroundChildren of parents with a mental illness (COPMI) have multiple psychological and developmental risks, including an increased lifetime risk of developing a mental illness themselves. Emotion regulation (ER) has been identified as a potential underlying mechanism of the transgenerational transmission of mental disorders. This study compares ER strategies in parents with and without a mental illness and their children. Further, it aims to examine the relationship between parents and children’s psychopathology with a focus on the role of parental and child ER.MethodsParticipants were 96 COPMI (77% female) and 99 children of parents without mental illness (COPWMI, 83% female) aged 4–16 years and their parents. Psychopathology and ER strategies of parents and children were assessed with a series of questionnaires.ResultsBoth COPMI and their parents showed significantly more psychopathology and more maladaptive and adaptive ER strategies in comparison with COPWMI and their parents. Parent and child adaptive ER strategies mediated the relationship between the psychopathology of parents and children only when child maladaptive ER strategies were low.Conclusions The findings further our understanding of the processes by which parental psychopathology affects child outcomes. Our findings highlight the importance of implementing preventive programs that specifically target the reduction of maladaptive ER in children to interrupt the transgenerational transmission of psychopathological symptoms.

Integrating the family stress model within a longitudinal sibling-adoption study of adolescent externalizing behavior.

Using a sample of linked adopted children, adoptive and birth parents (N = 561), and biological siblings residing in the birth parent home (N = 191), we examined the role of genetics within family stress processes. We tested parental hostility (7 years) as a mediator of the associations between socioeconomic strain and rearing parent psychopathology (4 years) and adolescent externalizing behaviors (11 years) in adoptive and biological parent homes. Next, we examined parent social support (4 years) as a moderator of paths from socioeconomic strain and parent psychopathology to parental hostility. Parental hostility significantly mediated effects of socioeconomic strain and parent psychopathology on adolescent externalizing behaviors in biological and adoptive parent homes, respectively. Equivalence testing of the paths to adolescent externalizing behaviors across family types indicated a negligible role of passive gene-environment correlation. Parent social support significantly attenuated the effect of parent psychopathology on parental hostility in biological families. Birth parent externalizing behaviors were not significantly associated with adoptee externalizing behaviors nor adoptive parent hostility, suggesting negligible heritable risk or evocative gene-environment processes. Full- and half-sibling correlations indicated that children's unique rearing contexts contributed to the parenting they received and the externalizing behavior they exhibited. Implications for intervention are discussed.

Integrating parental psychopathologies in autism spectrum disorder care: Toward a holistic family-centric approach.

Integrating parental psychopathologies in autism spectrum disorder care: Toward a holistic family-centric approach.

Maternal psychopathology is differentially associated with adolescent offspring neural response to reward given offspring ADHD risk

Reinforcement sensitivity is a hypothesized attention-deficit/hyperactivity disorder (ADHD) intermediate phenotype but its role in transgenerational transmission of ADHD-linked psychopathology risk is largely unknown. We examined, in a carefully phenotyped, N = 123 sample of adolescents (Mage = 15.27 years, SD = 0.984; 61.78% boys), whether (1) parental psychopathology is differentially associated with fMRI-indexed neural response to reward receipt and (2) both maternal and paternal psychopathology are associated with neural response to reward; across adolescents at-risk for and not at-risk for ADHD. Indices of parental psychopathology were differentially associated with adolescent offspring neural response to reward such that across measures, parental psychopathology was negatively or not associated with offspring superior frontal gyrus (SFG) response to reward receipt in adolescents at-risk for ADHD, but parental psychopathology was positively associated with offspring SFG response in adolescents not at-risk. Further, across measures, greater maternal psychopathology was associated with blunted adolescent SFG response to reward in adolescents at-risk for ADHD whereas greater maternal externalizing problems were linked to enhanced adolescent SFG response in adolescents not at-risk. Across measures, paternal psychopathology was not associated with adolescent response to reward, in either group. ADHD risk confers differential reward-related susceptibility to the effects of parental psychopathology. Results also show this association is nonspecific in terms of parental psychopathology type but is specific to maternal psychopathology.

Potential Risk Factors and Early Experiences to the Development of Social Phobia in Adolescents

This paper explores potential risk factors and underlying experiences associated with the development of social phobia in adolescents, emphasizing the importance of early intervention and treatment. Factors investigated include gender roles, cultural influences, socioeconomic status, parental psychopathology, alcohol use, early memories, and family environment. Gender differences reveal higher rates of social phobia among females, while collectivist cultures and adverse childhood experiences significantly contribute to its prevalence. Dysfunctional family environments are associated with an increased risk and higher persistence of social phobia, particularly due to their influence on childhood experiences. Alcohol use may exacerbate symptoms and lead to higher persistence due to its link to alcohol dependence. Parental psychopathology demonstrates a higher prevalence and co-occurrence with other comorbidities across all ages. Low socioeconomic status and popularity serve as additional risk factors. The paper critiques understudied aspects of these factors and suggests future research directions to enhance understanding and inform effective prevention strategies.