Anxiety and depression as correlates of self-reported behavioural inhibition in normal adolescents
Introduction
Some children and adolescents are characterised by a behaviourally inhibited temperament (Kagan, Reznick, & Snidman, 1988). In infancy, these children are irritable, and in childhood they tend to be unusually shy and to react with fear and withdrawal in novel and/or unfamiliar social situations (e.g. Kagan, Reznick, & Snidman, 1987). Behavioural inhibition remains relatively stable from early to middle and late childhood (Kagan et al., 1988; Scarpa, Raine, Venables, & Mednick, 1995; Gest, 1997), although it should be noted that this behavioural pattern is unremittingly present in only 10% of children who manifest it in its extreme and who show a high and stable heart rate (see Turner, Beidel, & Wolff, 1996). Research has shown that these children seem to be at risk for developing anxiety disorders. Evidence for this comes from a study by Biederman and colleagues (1993). In this study, pre-school children were followed for a 3-year period. Results showed that children initially identified as behaviourally inhibited were subsequently more likely to develop anxiety disorders compared to control children (i.e. children who at study onset were not classified as behaviourally inhibited). Not only social phobia but also separation anxiety disorder and multiple anxiety disorders were significantly more prevalent in the subsample with behavioural inhibition. The Biederman et al. (1993) study also found that in the group of inhibited children, the rates of all anxiety disorders increased markedly from baseline to follow-up (for a review of behavioural inhibition studies in pre-school children, see Biederman, Rosenbaum, Chaloff, & Kagan, 1995).
Few studies have examined the relationship between behavioural inhibition and anxiety and other psychopathological symptoms in older children. One exception is a recent study by Muris and colleagues (1999). In that study, normal children (N=152) aged 12 to 14 years were provided with a definition of behavioural inhibition and then asked to classify themselves as either low, middle, or high on behavioural inhibition. In addition, children completed measures of anxiety disorders symptoms and depression. Results indicated that children who scored high on behavioural inhibition were found to have higher levels of anxiety and depression compared to children who classified themselves as low or middle on behavioural inhibition. Moreover, children high on behavioural inhibition more frequently exhibited (multiple) anxiety disorders symptoms in the subclinical range.
In their critical review on the relationship between behavioural inhibition and anxiety disorders, Turner and colleagues (1996, pp. 170–171) have rightly remarked that “BI [behavioural inhibition] might represent one, but not the only, factor associated with the development of anxiety disorders. That is, BI is neither necessary nor sufficient for the development of anxiety disorders, although the presence of BI may make an individual more vulnerable to the development of these disorders.” To date, the most likely interpretation of the relationship between behavioural inhibition and anxiety disorders is that behavioural inhibition is one manifestation of a genetic vulnerability factor, such as neuroticism or trait anxiety, which in interaction with negative environmental influences (e.g. stressful life events, parental rearing, and specific learning experiences) may produce an anxiety disorder (see Craske, 1997; Muris & Merckelbach, 2000; Turner et al., 1996).
So far, research has emphasised that behavioural inhibition is a risk factor for developing childhood anxiety disorders. In considering future directions in research on behavioural inhibition, Biederman et al. (1995, p. 77) comment on the specificity of the association between behavioural inhibition and anxiety: “Is behavioural inhibition in children specifically or exclusively antecedent to anxiety disorder as opposed to other psychopathology . . . ?” Note in passing that in the Muris et al. (1999) study, behaviourally inhibited children also displayed elevated levels of depression. Thus, it remains possible that behavioural inhibition not only serves as an antecedent for anxiety disorders but is also directly involved in the aetiology of childhood depression. Another possibility is that the connection between behavioural inhibition and depression is carried by anxiety. In a recent longitudinal study, Cole, Peeke, Martin, Truglio, and Seroczynski (1998) found that high levels of anxiety at one point in time predicted high levels of depression at a subsequent point in time even when controlling for prior levels of depression. This result indicates that depression in children is a consequence of high levels of anxiety. Thus, according to this line of reasoning, behavioural inhibition leads to anxiety which in turn results in depression.
The current study further examined the connection between self-reported behavioural inhibition, on the one hand, and anxiety and depression, on the other hand, in a large sample of 968 adolescents. Two measures of behavioural inhibition were used. First, adolescents answered a set of questions about typical behavioural inhibition features. Second, they were provided with a definition of behavioural inhibition and then asked to classify themselves as low, middle, or high on behavioural inhibition. In addition, adolescents completed the Spence Children's Anxiety Scale (SCAS; Spence, 1997; Spence, 1998), a questionnaire designed to measure anxiety disorders symptoms in terms of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 1994) and the Children's Depression Inventory (CDI; Kovacs, 1981), a commonly used measure of depressive symptoms. It was investigated whether self-reported behavioural inhibition was positively associated with symptoms of anxiety disorders and depression. Furthermore, structural equations modelling was used to explore the role of behavioural inhibition in the radicalisation of anxiety and depression symptoms. Four plausible models were tested. In the first model, behavioural inhibition leads to both anxiety disorders symptoms and depression (BI→Anxiety and Depression). In the second model, behavioural inhibition causes anxiety disorders symptoms which, in turn, results in depression (BI→Anxiety→Depression). In the third model, behavioural inhibition leads to depression which, in turn, results in anxiety disorders symptoms (BI→Depression→Anxiety). The fourth and final model tested whether behavioural inhibition is an antecedent of anxiety disorder symptoms or a consequence of such symptoms. In this model, anxiety leads to behavioural inhibition, which in its turn causes depression (Anxiety→BI→Depression). On the basis of previous research on the connection between behavioural inhibition and psychopathology, it was expected that either the first or the second model would provide the best fit of the data.
Section snippets
Participants
Nine hundred and sixty-eight adolescents (496 boys and 472 girls; mean age 14.2 years, SD=1.4; range 12–18 years) were recruited from a regular secondary school in Stein/Beek (Limburg), The Netherlands. No exact information about the socio-economic background, ethnicity, and family structure of the adolescents was available. On the basis of information provided by the staff of the school, the percentages of adolescents with low, middle, and upper socio-economic background were estimated at 25%,
General findings
The left panel of Table 1 displays descriptive statistics for the various questionnaires used in the current study. All questionnaires were found to have sufficient internal consistency. Cronbach's alphas were 0.72 for BIS, 0.83 for CDI, and varied between 0.60 (fears of physical injury) and 0.91 (total score) for the various SCAS scales. Furthermore, t-tests revealed significant gender differences for BIS [t(966)=4.4, P<0.001], CDI [t(932.4, adjusted df)=3.3, P<0.005], SCAS total score [t
Discussion
Behavioural inhibition is a temperamental factor characterised by shyness, fearfulness, and withdrawal in response to novel and/or unfamiliar social situations (Kagan et al., 1988). In the past decade, a number of studies have provided evidence for behavioural inhibition being a risk factor for developing anxiety disorders (for reviews, see Biederman et al., 1995; Turner et al., 1996). Most of these studies relied on samples of pre-school children in which behavioural inhibition was assessed by
Acknowledgements
Children, parents, and staff of the Groenewald–Proosdijveld Scholengemeenschap in Stein/Beek (Limburg), The Netherlands, are thanked for their participation in this study.
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