The current study sought to advance previous work by examining relations between parent anxiety and several different child symptoms in a sample including children at risk for psychopathology due to parent anxiety disorders. The study further tested the possible additive effects of parent depression or externalizing symptoms on extant relations between parent anxiety and child symptoms. Finally, the study considered whether relations between parent and child symptoms were moderated by levels of parent anxiety symptoms.
Consistent with our expectations, results provided partial support for the notion of multifinality (Cicchetti and Rogosch 1996
). As hypothesized, we found that parent anxiety symptoms were significantly related to both child anxiety and depression symptoms, indicating that one risk factor may predict more than one problem. These results are consistent with several previous studies that have found parent anxiety to predict both child anxiety and depression problems (e.g., Biederman et al. 1991
; Turner et al. 1987
), however they counter some prior work that has found parent anxiety to only (or more strongly) predict child anxiety (Beidel and Turner 1997
; Biederman et al. 2006
; Merikangas et al. 1998
). Such inconsistency in results across studies may be a function of differences in their statistical methodology. In particular, studies that have found parent anxiety to predict only child anxiety (e.g., Merikangas et al. 1998
) have controlled for other forms of comorbid parent psychopathology (i.e., parent depression and/or ASPD) in analyses, whereas studies that have found parent anxiety to predict both child anxiety and depression have not. Therefore, our observation of significant relations between parent anxiety and child depression symptoms may be due in part to the additional risk of concomitant depression or externalizing symptoms among parents. Providing support for this idea, although bivariate correlations indicated that parent anxiety symptoms were significantly related to child depression symptoms, regression models indicated that parent anxiety symptoms were no longer associated with child depression symptoms when either parent depression or externalizing symptoms were included in the models we tested. As such, it is possible that the observed relation between parent anxiety symptoms and child depression symptoms would be absent if other parent symptoms were controlled. Therefore, our findings may be representative of the genuine co-occurrence of these symptom types among both parents and children. Alternatively, our use of continuous rather than dichotomous measures of parent and child psychopathology may have optimized the detection of significant relations between parent and child symptom variables. Future work investigating this research question that utilizes symptom measures of parent and child psychopathology will be helpful in providing further support for this finding.
Although we found that parent anxiety symptoms were significantly related to both child anxiety and depression symptoms, counter to our predictions, parent anxiety symptoms were not significantly related to child externalizing symptoms. Whereas these results differ from previous work that has found parent anxiety problems to place children at greater risk for both internalizing and externalizing problems (e.g., Biederman et al. 1991
; Silverman et al. 1988
; Turner et al. 1987
), it is important to note that such studies have compared children of parents with anxiety disorders to children of parents without any psychopathology, rather than examining relations among variables. Therefore, when compared to children of healthy parents, greater dysfunction of any kind among children of parents with anxiety disorders may be expected. Indeed, our examination of differences in child symptoms by parent clinical status indicated that children of parents with anxiety disorders had higher mean levels of all types of symptomatology relative to children of parents with no psychiatric diagnosis.
In addition, in accordance with the notion of cumulative risk, we hypothesized that both parent depression and externalizing symptoms would significantly contribute to the prediction of child symptoms, beyond the contribution of parent anxiety symptoms. In support of this hypothesis, we found that parent externalizing symptoms had significant additive effects on child anxiety symptoms, even after accounting for the effects of parent anxiety symptoms. Although no previous research has directly tested this hypothesis, our results are consistent with other high-risk studies that have found parent externalizing problems to independently predict child internalizing problems (Burstein et al. 2006
; Marmorstein et al. 2004
), after controlling for the effects of other parent psychopathology.
Contrary to our expectations, parent depression symptoms had no significant additive effects on relations between parent anxiety and child anxiety or depression symptoms, after already accounting for parent anxiety symptoms. These results are in agreement with prior work that has found no significant differences in rates of anxiety and depression between children of parents with only anxiety disorders relative to children of parents with comorbid anxiety and depressive disorders (Beidel and Turner 1997
; Warner et al. 1995
). From a statistical standpoint, parent anxiety and depression symptoms may both significantly predict child symptoms, yet due to their high degree of covariation, parent depression symptoms may fail to predict unique variance in child symptoms when they are considered with parent anxiety symptoms. From a phenomenological perspective, it is possible that the psychosocial and environmental context that occasions parent depression symptoms poses no greater risk to children if they are already exposed to parent anxiety symptoms. For instance, separate lines of research have identified many of the same negative parenting behaviors (i.e., rejection, low warmth, control/intrusive behavior) as correlates of both parent depression (Goodman et al. 1994
; Hammen 1991
) and parent anxiety (Ginsburg and Schlossberg 2002
; Wood et al. 2003
). In contrast, parenting behaviors and interactional styles that may be more typical of parents with externalizing problems, such as hostile behavior and harsh discipline (Loney et al. 2007
; Patterson et al. 1989
) have previously been shown to predict child anxiety (Katz and Low 2004
; Rodriguez 2003
) and may confer additional distinct risks for child anxiety symptoms, even after accounting for the effects of parent anxiety symptoms. Therefore, children of parents who present with both anxiety and externalizing problems may be at greater risk for anxiety relative to children of parents who present only with anxiety problems. Future research that identifies the environmental processes that may be common and specific to each form of parent psychopathology will enable examination of this possibility.
Finally, though we hypothesized that relations between parent depression or externalizing symptoms and child symptoms would be stronger in the presence of high vs. low parent anxiety symptoms, only one interactive effect emerged. When the pattern of this interaction effect was examined, its direction was contrary to our expectations. Specifically, results indicated that at low and moderate levels of parent anxiety symptoms, the relationship between parent and child externalizing symptoms was strongly positive and significant, however at high levels of parent anxiety symptoms, the strength of this relationship was reduced. Thus, high levels of parent anxiety symptoms appear to attenuate the magnitude of the relationship between parent and child externalizing symptoms. In view of these findings, it is possible that parent anxiety symptoms increase parental conscientiousness and concern. In turn, these parental characteristics may offset negative parenting practices, such as poor monitoring and inconsistent discipline, which have been found to mediate the relationship between parent and child externalizing problems (Dogan et al. 2007
). Additional studies that examine the associated mechanisms of this interaction pattern may provide evidence for this explanation.
The results of this study are not without several limitations. First, because these data are concurrent the direction of effects and causation cannot be definitively established. Although findings of this study are suggestive of possible risk pathways, it is equally plausible that child symptoms influence parent symptoms, or more likely, that these problems operate in a bi-directional fashion. It may also be that the relations between parent and child symptoms are due in part to their association with another psychosocial risk factor (e.g., parenting, family environment). Albeit preliminary, results of the current study are an important first step to advancing our knowledge of the relations between parent and child symptoms among children at greater risk for psychopathology. Future longitudinal studies that examine these and other risk factors will be helpful in refining our understanding of how parent symptoms might influence environmental processes, and how these risks may operate over time.
Second, given that parents were the only informants of their psychological symptoms, the measurement of these variables is subject to the biases inherent to all self-report instruments. Similarly, because parents provided the only report of child externalizing symptoms, our findings for this variable remain vulnerable to the confound of informant. For example, it may be that, relative to parents who present only with externalizing symptoms, parents who present with both anxiety and externalizing symptoms understate externalizing symptoms in their children or are less aware of their presence. However, our use of child self-reports of their own symptoms of anxiety and depression both reduced the possibility of a shared method effect and decreased the likelihood that parents’ own psychopathology influenced our estimation of child internalizing problems. In the future, it will be useful to supplement self-report data with observational and multi-informant data in order to enhance our measurement of parent and child symptomatology.
Third, a moderate sample size and limited power prohibited our examination of the 3-way interaction of parent psychopathology symptoms in relation to child symptoms. However, our sample size was appropriate to detect the main effects that were observed in the regression models we tested (Cohen 1992
) and power analyses indicated that the current sample size had a power of 0.70 to detect the observed interaction effect. Studies that employ larger samples will be useful in examining higher-order interactions and providing further support for the current results. Finally, the results of this study may not generalize to clinical samples or to the general population. Future high-risk family studies will be useful in further exploring the additive and interactive effects of parent comorbid symptoms in relation to child symptoms.
Even with these limitations, the current study exhibits a number of strengths and has important implications for future clinical and theoretical models. The results of this study add to an increasing body of literature documenting the relationship between parent anxiety and several different child problems. It is also one of the few studies to directly examine the additive and interactive effects of multiple types of parent symptoms on relations between parent and child symptoms. Findings of this study suggest that parent anxiety problems may broadly confer risk for child emotional and behavioral symptoms. Further, results demonstrate that, beyond parent anxiety symptoms, parent externalizing symptoms significantly contribute to child anxiety symptoms. Although many high-risk and clinical studies focus on examining the relationship between parent anxiety and child anxiety (e.g., Biederman et al. 1991
; Cobham et al. 1998
; Kendall et al. 2008
), results of this study suggest that it may also be important to consider parent externalizing symptoms (i.e., hostility and paranoid behavior) as they relate to child anxiety in research and treatment. Moreover, future studies that examine the additive risk and psychosocial sequalae of a variety of parent symptoms may be helpful in determining how to enhance the efficacy and cost-effectiveness of interventions with at risk youth.