Mood and anxiety disorders are common mental disorders with peak age of onset in first two decades of life. They exert significant negative impact on all aspects of life. Considering the personal and societal cost of these disorders, prevention is an important goal. Some of the key risk factors for depression and anxiety disorders in young people involve families. Understanding modifiable factors have the potential to play a larger role in preventive efforts.
Parental warmth , authoritative parenting , effective and consistent discipline, parental monitoring and good family communication and problem solving are factors shown to influence the occurrence of anxiety and depression in youth.
Marie Bee Hui Yap et al reports the results of a review ( Systematic Review / meta analysis) aiming to identify factors that parents can potentially modify to prevent the development of depression and anxiety disorders in their adolescent child. All studies with retrospective (including case control), longitudinal, or cross-sectional study design where one or more potentially modifiable parenting factors were included in analyses as predictors for adolescent depressive or anxiety symptoms or diagnoses, were included.
181 articles reporting 516 associations were identified via the systematic search.
The factors emerged the level of evidence :
Authoritarian Parenting :Findings from three longitudinal studies suggest that higher levels of authoritarian parenting predict higher levels of depression. Mean effect size suggest only non-significant small effect, with high heterogeneity.
Authoritative Parenting : No clear finding.
Autonomy Granting : Two longitudinal studies reporting significant associations, the body of evidence linking higher levels of autonomy granting with lower levels of depression is strong.
Aversiveness :The evidence suggests that higher levels of aversiveness are associated with higher levels of anxiety and depression.
Encouraging Sociability : Evidence linking encouraging sociability with anxiety and depression is weak.
Inconsistent Discipline: Higher levels of inconsistent discipline are associated with higher levels of depression.
Inter-parental conflict : Evidence suggest links with anxiety or depression with small effect sizes.
Over involvement: A medium effect size seen for link between over involvement and depression.
Warmth: Higher levels of warmth during adolescents are associated with lower levels of anxiety in adulthood (medium mean effect size) and lower levels of depression (small mean effect size, with high heterogeneity).
Withdrawal : higher levels of withdrawal are associated with higher levels of anxiety. Evidence linking withdrawal and depression is weak
Parental factors predicting depression are more similar than different from those predicting anxiety disorders. Warmth ,Inter-parental conflict, Over-involvement , Aversiveness are shown as factors with sound evidence base for link with both disorders.Autonomy granting and Monitoring are factors with sound evidence base for depression.Many of the key parental influences on the development of adolescent depression and anxiety are non-specific.
Limitations: Data from more than 41% of included studies could not be used in meta-analyses (studies with non- population samples,absence of data that is reported in a manner that could be used in a meta analysis).Moderators or mediators of the associations between parental factors and adolescent depression or anxiety was not systematically reviewed. Causal role of these factors remains to be determined by well-designed rando- mised controlled trials of prevention programs that target these factors specifically and assess the mediating effects directly.
Conclusions: Certain parental factors have good evidence base for predicting adolescent depression and anxiety. Intervention/ prevention programmes should utilise this knowledge.
Summary of the article:
Yap MB, Pilkington PD, Ryan SM, Jorm AF. J Affect Disord. 2014 Mar;156:8-23