Research report
Grandparental anxiety and depression predict young children's internalizing and externalizing problems: The generation R study

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Abstract

Background

Family history is a major risk factor for child problem behaviour, yet few studies have examined the association between grandparental psychiatric disorder and child problem behaviour. Results are inconsistent as to whether the effect of grandparental depression on child problem behaviour is independent of parental psychopathology.

Methods

Mothers and their children participated in an ethnically Dutch subcohort of a population-based prospective cohort in the Netherlands. N = 816 (66%) mothers and n = 691 fathers participated in the prenatal interviews. N = 687 (84%) mothers and children and n = 565 (82%) fathers participated three years postpartum. (Grand)parental psychopathology was assessed during pregnancy of the mothers with the Family Informant Schedule and Criteria (FISC), the Composite International Diagnostic Interview (CIDI) and the Brief Symptom Inventory (BSI). Child behaviour was assessed with the Child Behavior Checklist (CBCL) by mother and father when the child was three years old.

Results

Grandparental anxiety disorder predicted maternal reports of children's internalizing problems (OR = 1.98, 95% C.I. (1.20, 3.28), p-value < 0.01) and externalizing problems (OR = 1.73, 95% C.I. (1.04, 2.87), p-value = 0.03), independent of parental psychopathology. Results were similar for grandparental depression; internalizing OR = 1.75, 95% C.I (1.11, 2.75), p-value = 0.02 and externalizing OR = 1.67, 95% C.I. (1.05, 2.64) p-value = 0.03. However, grandparental psychopathology was not associated with children's problem behaviour as reported by the father.

Limitations

Information on grandparental lifetime psychiatric disorder was assessed through a parental interview which may have led to an underestimation of the prevalence rates.

Conclusions

These results confirm the importance of a family history including not only the parental but also the grandparental generations.

Introduction

Family history is one of the most important risk factors for developing internalizing and externalizing problems at a young age and may help identification of young children at risk for problem behaviours (Bayer et al., 2008, Goodman and Gotlib, 1999). Studies of depressed or anxious children indicated that first degree relatives have higher prevalence rates of depressive disorders compared to the first degree relatives of controls (Birmaher et al., 1996, Klein et al., 2001, Kovacs et al., 1997). Overall, children with a depressed parent are three times more likely to develop a depressive disorder than children of healthy parents (Birmaher et al., 1996). However, children of depressed or anxious parents are not only at risk for internalizing behaviours. They are also at risk for externalizing behaviours (Beidel and Turner, 1997, Connell and Goodman, 2002, O'Connor et al., 2002).

Goodman and Gotlib (1999) provided an integrated model for the transmission of risk to children of depressed mothers. Their model posits that there are four possible mechanisms through which maternal depression can adversely affect child behaviour. The first mechanism is through genetic factors as children inherit 50% of their DNA from their mother. The second mechanism proposes that maternal depression (during pregnancy) causes abnormal fetal development. These abnormalities may manifest after birth as, for example, behavioural inhibition. Third, the depressed mother may expose her child to negative cognitions, behaviours and affect which consequently place the child at risk for developing behavioural problems. Studies assessing the interaction between depressed mothers and their children documented numerous parenting difficulties among depressed mothers with these mothers displaying more hostile, irritable and intrusive behaviours towards their children (Lovejoy et al., 2000). The fourth mechanism refers to contextual stressors of maternal depression that mediate the association between maternal depression and child problem behaviour. Examples of such contextual stressors are low social support, marital conflict and parenting stress.

While there is an extensive amount of research assessing the association between parental psychopathology and child mental health, to our knowledge, only four studies have gone beyond the assessment of two successive generations (Hammen et al., 2004, Olino et al., 2008, Pettit et al., 2008, Weissman et al., 2005). Yet, the familial risk is insufficiently evaluated when only assessing parental history. Knowledge of family history including the grandparents will help identifying children in need for prevention and treatment programs. The four existing studies reported an increased risk for internalizing and externalizing problems in children and adolescents in the presence of grandparental depression. However, results are inconsistent as to whether the effect of grandparental depression on child problem behaviour is independent of (e.g. mediated by) psychopathology of the parental generation. This inconsistency may be due to some limitations of the existing studies. First, most of the studies did not assess psychopathology of all four grandparents and parents (Hammen et al., 2004, Pettit et al., 2008, Weissman et al., 2005). Second, most importantly, none of the studies assessed global psychiatric symptoms next to lifetime psychiatric diagnoses to better assess psychopathology of the parental generation with a continuous measure. Third, most studies only took depression of the parental generation into account (Hammen et al., 2004, Pettit et al., 2008, Weissman et al., 2005). As a result it is not clear whether the risk of grandparental depression is transmitted specifically through parental depression or may also be transmitted through other parental psychopathology. For example, research demonstrated substantial sharing of genetic and, to a lesser extent, environmental factors across depression and anxiety indicating a common underlying vulnerability (Kendler et al., 2007, Kendler et al., 2003). Also, it was found that relatives of persons with depression had higher rates of dysthymia but also substance abuse disorders (Goldstein et al., 1994). By disregarding the three issues raised above, studies may not have well captured the genetic and environmental mechanisms underlying the risk transmitted. Also, except for one study sample sizes were relatively small (Hammen et al., 2004). This may have reduced power to detect significant associations between grandparental psychopathology and grandchild problem behaviours.

To address the issues raised, we examined whether grandparental anxiety and depressive disorder predicted internalizing and externalizing problems in a large community sample of preschoolers. Next we assessed whether this association was independent of psychopathology of the parental generation. Diagnostic information on the (biological) grandparental and parental generations was complete and included lifetime psychiatric diagnoses and psychiatric symptoms assessed with a continuous measure at two time points. In this way we wanted to account for as much genetic and environmental variation as possible. To provide further insights in the association between grandparental and child psychopathology, we additionally assessed whether the association was further mediated by maternal sensitivity (available for a subgroup of participating mothers and children) and maternal parenting stress. Mother reports of child behaviour as well as father reports of child behaviour were available and provided data from two informants.

Section snippets

Setting

The study was conducted within Generation R, a population-based prospective cohort from fetal life onwards in Rotterdam, the Netherlands, which has been described in detail (Jaddoe et al., 2008).

In a randomly assigned subgroup of Dutch pregnant women and their children, the Focus Cohort, detailed assessments were conducted including prenatal psychiatric interviews. This subgroup is ethnically homogeneous to exclude confounding or effect modification by ethnicity. All children were born between

Results

Results are presented using the 80th percentile as a cut-off point for child problem behaviour. Using the 75th and 85th percentiles as cut-off points yielded similar results.

Descriptive statistics for the total sample (N = 687) are summarized in Table 1. Univariate associations between (grand)parental characteristics and child problem behaviour are summarized in Table 2. Parental prenatal psychiatric symptoms were significantly associated with child internalizing problems (OR = 8.76, se = 0.42,

Discussion

The main finding of this study was that anxiety and depressive disorders of the grandparental generation predicted child problem behaviour independent of psychopathology of the parental generation. Children with one or more grandparents with a lifetime history of an anxiety or depressive disorder had an increased risk of internalizing and externalizing problems at the age of three years.

To the best of our knowledge, an independent effect of grandparental psychopathology has only reported once (

Role of funding source

Funding for this study was provided by Erasmus Medical Centre, Rotterdam, Erasmus University Rotterdam, the Netherlands Organization for Health Research and Development (ZonMw, Grant No. 10.000.1003) and the Sophia Foundation For Scientific Research (SSWO; grant 547, 2008); The Erasmus Medical Centre, ZonMw and SSWO had no further role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for

Conflict of interest

All authors declare that they have no conflicts of interest.

Acknowledgements

The Generation R Study is conducted by the Erasmus Medical Centre in close collaboration with the Erasmus University Rotterdam, School of Law and Faculty of Social Sciences, the Municipal Health Service Rotterdam area, Rotterdam, the Rotterdam Homecare Foundation, Rotterdam, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR), Rotterdam. We gratefully acknowledge the contribution of general practitioners, hospitals, midwives and pharmacies in Rotterdam. The first phase of the

References (49)

  • M.D.S. Ainsworth et al.

    Infant–mother attachment and social development: ‘socialization’ as a product of reciprocal responsiveness to signals

  • N.C. Andreasen et al.

    The family history method using diagnostic criteria: reliability and validity

    Arch. Gen. Psychiatry

    (1977)
  • G. Andrews et al.

    The psychometric properties of the Composite International Diagnostic Interview

    Soc. Psychiatry Psychiatr. Epidemiol.

    (1998)
  • J. Barlow et al.

    Group-based parent-training programmes for improving emotional and behavioural adjustment in children from birth to three years old

    Cochrane Database Syst. Rev.

    (2010)
  • M. Bartels et al.

    Young Netherlands Twin Register (Y-NTR): a longitudinal multiple informant study of problem behavior

    Twin Res. Hum. Genet.

    (2007)
  • J.K. Bayer et al.

    Early childhood aetiology of mental health problems: a longitudinal population-based study

    J. Child Psychol. Psychiatry

    (2008)
  • H.R. Bogner et al.

    Are higher rates of depression in women accounted for by differential symptom reporting?

    Soc. Psychiatry Psychiatr. Epidemiol.

    (2004)
  • R.H. Bradley et al.

    Externalizing problems in fifth grade: relations with productive activity, maternal sensitivity, and harsh parenting from infancy through middle childhood

    Dev. Psychol.

    (2007)
  • A. Caspi et al.

    Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene

    Science

    (2003)
  • T.F. Chapman et al.

    Effects of informant mental disorder on psychiatric family history data

    Am. J. Psychiatry

    (1994)
  • A.M. Connell et al.

    The association between psychopathology in fathers versus mothers and children's internalizing and externalizing behavior problems: a meta-analysis

    Psychol. Bull.

    (2002)
  • E.M. Cummings et al.

    Effects of marital conflict on children: recent advances and emerging themes in process-oriented research

    J. Child Psychol. Psychiatry

    (2002)
  • E.M. Cummings et al.

    Towards a family process model of maternal and paternal depressive symptoms: exploring multiple relations with child and family functioning

    J. Child Psychol. Psychiatry

    (2005)
  • E. de Beurs

    Brief Symptom Inventory. PITS B.V

    (2004)
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