Skip to main content
Top
Published in: Child and Adolescent Psychiatry and Mental Health 1/2021

01-12-2021 | Generalized Anxiety Disorder | Research article

Longitudinal association between parental-to-child-Maltreatment and self-reported Generalized Anxiety Disorder symptoms in Pakistani Adolescents

Authors: Maryam Pyar Ali Lakhdir, Ghazal Peerwani, Salman Muhammad Soomar, Apsara Ali Nathwani, Salima Farooq, Naureen Akber Ali, Asif Khaliq, Muhammad Masood Kadir, Syed Iqbal Azam

Published in: Child and Adolescent Psychiatry and Mental Health | Issue 1/2021

Login to get access

Abstract

Background

Parent-to-child maltreatment is considered one of the risk factors for Generalized Anxiety Disorder (GAD) symptoms, but this hypothesis has not been adequately tested in Pakistani settings.

Aim

This study aimed to examine the association between parent-to-child maltreatment and the risk of developing GAD symptoms among adolescents.

Methods

The association of none to rare, occasionally, and frequently parent-to-child maltreatment with the incidence of GAD symptoms was investigated in a sample of 800 adolescents aged 11–17 years who were followed for two years. Parent-to-child maltreatment was assessed using ICAST-C (International child abuse screening tool). GAD Symptoms were determined by SCARED (Screen for children anxiety-related disorders). Cox Proportional Algorithm was used to estimate risk ratios.

Results

Among children with both uneducated parents, frequently maltreatment was associated with 7.31 (2.20–24.04) times the risk of GAD symptoms compared to none to rare maltreatment. In contrast, the risk of GAD symptoms in frequently maltreated children was 5.58 times (1.40–21.97) than negligibly maltreated children with either educated parent.

Conclusion

The frequency of parent-to-child maltreatment is significantly associated with an increased risk of developing GAD symptoms in which parental education plays a crucial role. Parents should be imparted with the awareness of the consequences of child maltreatment. In Pakistani settings the need to have this awareness is even more necessary due to the culturally acceptable disciplinary measures used by parents.
Literature
2.
go back to reference WHO. Global accelerated action for the health of adolescents (AA-HA!). Geneva: World Health Organisation; 2017. WHO. Global accelerated action for the health of adolescents (AA-HA!). Geneva: World Health Organisation; 2017.
5.
go back to reference Association, AP. Diagnostic and statistical manual of mental disorders. 2013: 5th ed. Washington, DC. Association, AP. Diagnostic and statistical manual of mental disorders. 2013: 5th ed. Washington, DC.
6.
7.
go back to reference Green H, et al. Mental health of children and young people in Great Britain, 2004. Basingstoke: Palgrave Macmillan; 2005.CrossRef Green H, et al. Mental health of children and young people in Great Britain, 2004. Basingstoke: Palgrave Macmillan; 2005.CrossRef
8.
go back to reference Jayashree K, et al. Depression and anxiety disorders among schoolgoing adolescents in an urban area of South India. Indian J Commun Med. 2018;43(Suppl 1):S28–32. Jayashree K, et al. Depression and anxiety disorders among schoolgoing adolescents in an urban area of South India. Indian J Commun Med. 2018;43(Suppl 1):S28–32.
9.
go back to reference Zarafshan H, Mohammadi MR, Salmanian M. Prevalence of anxiety disorders among children and adolescents in Iran: a systematic review. Iran J Psychiatry. 2015;10(1):1–7.PubMedPubMedCentral Zarafshan H, Mohammadi MR, Salmanian M. Prevalence of anxiety disorders among children and adolescents in Iran: a systematic review. Iran J Psychiatry. 2015;10(1):1–7.PubMedPubMedCentral
10.
go back to reference Burstein M, et al. Threshold and subthreshold generalized anxiety disorder among US adolescents: prevalence, sociodemographic, and clinical characteristics. Psychol Med. 2014;44(11):2351–62.PubMedPubMedCentralCrossRef Burstein M, et al. Threshold and subthreshold generalized anxiety disorder among US adolescents: prevalence, sociodemographic, and clinical characteristics. Psychol Med. 2014;44(11):2351–62.PubMedPubMedCentralCrossRef
11.
go back to reference Afzal S, Sarfraz H, Hassan S. Prevalence of generalized anxiety disorder in adolescents and youth in Lahore urban community Pakistan. HealthMED; 2014: p. 1192. Afzal S, Sarfraz H, Hassan S. Prevalence of generalized anxiety disorder in adolescents and youth in Lahore urban community Pakistan. HealthMED; 2014: p. 1192.
12.
go back to reference Brown TA, Chorpita BF, Barlow DH. Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. J Abnorm Psychol. 1998;107(2):179–92.PubMedCrossRef Brown TA, Chorpita BF, Barlow DH. Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. J Abnorm Psychol. 1998;107(2):179–92.PubMedCrossRef
13.
go back to reference Wittchen HU. Generalized anxiety disorder: prevalence, burden, and cost to society. Depress Anxiety. 2002;16(4):162–71.PubMedCrossRef Wittchen HU. Generalized anxiety disorder: prevalence, burden, and cost to society. Depress Anxiety. 2002;16(4):162–71.PubMedCrossRef
14.
15.
go back to reference Carter R, Silverman WK, Jaccard J. Sex variations in youth anxiety symptoms: effects of pubertal development and gender role orientation. J Clin Child Adolesc Psychol. 2011;40(5):730–41.PubMedPubMedCentralCrossRef Carter R, Silverman WK, Jaccard J. Sex variations in youth anxiety symptoms: effects of pubertal development and gender role orientation. J Clin Child Adolesc Psychol. 2011;40(5):730–41.PubMedPubMedCentralCrossRef
16.
go back to reference Safren SA, et al. History of childhood abuse in panic disorder, social phobia, and generalized anxiety disorder. J Nerv Ment Dis. 2002;190(7):453–6.PubMedCrossRef Safren SA, et al. History of childhood abuse in panic disorder, social phobia, and generalized anxiety disorder. J Nerv Ment Dis. 2002;190(7):453–6.PubMedCrossRef
17.
go back to reference Dannlowski U, et al. Limbic scars: long-term consequences of childhood maltreatment revealed by functional and structural magnetic resonance imaging. Biol Psychiat. 2012;71(4):286–93.PubMedCrossRef Dannlowski U, et al. Limbic scars: long-term consequences of childhood maltreatment revealed by functional and structural magnetic resonance imaging. Biol Psychiat. 2012;71(4):286–93.PubMedCrossRef
18.
go back to reference Gilbert R, et al. Burden and consequences of child maltreatment in high-income countries. Lancet. 2009;373(9657):68–81.PubMedCrossRef Gilbert R, et al. Burden and consequences of child maltreatment in high-income countries. Lancet. 2009;373(9657):68–81.PubMedCrossRef
21.
go back to reference Lakhdir M, et al. 468 Prevalence of child abuse among children aged 11 to 17 years old in community settings of Karachi, Pakistan. London: BMJ Publishing Group Ltd; 2016.CrossRef Lakhdir M, et al. 468 Prevalence of child abuse among children aged 11 to 17 years old in community settings of Karachi, Pakistan. London: BMJ Publishing Group Ltd; 2016.CrossRef
22.
go back to reference Ali NS, Khuwaja AK. Magnitude and factors associated with child abuse in a mega city of developing country Pakistan. Iran J Pediatr. 2014;24(2):140. Ali NS, Khuwaja AK. Magnitude and factors associated with child abuse in a mega city of developing country Pakistan. Iran J Pediatr. 2014;24(2):140.
23.
go back to reference Siddiqui N. Parental education as a determinant of school choice: A comparative study of school types in Pakistan. Res Educ. 2017;99:003452371772586.CrossRef Siddiqui N. Parental education as a determinant of school choice: A comparative study of school types in Pakistan. Res Educ. 2017;99:003452371772586.CrossRef
24.
go back to reference Leung PW, et al. Prevalence and determinants of child maltreatment among high school students in Southern China: a large scale school based survey. Child Adolesc Psychiatry Ment Health. 2008;2(1):27.PubMedPubMedCentralCrossRef Leung PW, et al. Prevalence and determinants of child maltreatment among high school students in Southern China: a large scale school based survey. Child Adolesc Psychiatry Ment Health. 2008;2(1):27.PubMedPubMedCentralCrossRef
25.
go back to reference Juruena MF, et al. Hypothalamic-pituitary-adrenal axis dysfunction by early life stress. Neurosci Lett. 2021;759:136037.PubMedCrossRef Juruena MF, et al. Hypothalamic-pituitary-adrenal axis dysfunction by early life stress. Neurosci Lett. 2021;759:136037.PubMedCrossRef
26.
go back to reference Liao M, et al. Childhood maltreatment is associated with larger left thalamic gray matter volume in adolescents with generalized anxiety disorder. PLoS ONE. 2013;8(8):e71898.PubMedPubMedCentralCrossRef Liao M, et al. Childhood maltreatment is associated with larger left thalamic gray matter volume in adolescents with generalized anxiety disorder. PLoS ONE. 2013;8(8):e71898.PubMedPubMedCentralCrossRef
27.
go back to reference Calhoun BH, Ridenour TA, Fishbein DH. Associations between child maltreatment, harsh parenting, and sleep with adolescent mental health. J Child Fam Stud. 2019;28(1):116–30.PubMedCrossRef Calhoun BH, Ridenour TA, Fishbein DH. Associations between child maltreatment, harsh parenting, and sleep with adolescent mental health. J Child Fam Stud. 2019;28(1):116–30.PubMedCrossRef
28.
go back to reference Berzenski SR, Madden AR, Yates TM. Childhood emotional abuse characteristics moderate associations with adult psychopathology and caregiving. Child Abuse Negl. 2019;87:77–87.PubMedCrossRef Berzenski SR, Madden AR, Yates TM. Childhood emotional abuse characteristics moderate associations with adult psychopathology and caregiving. Child Abuse Negl. 2019;87:77–87.PubMedCrossRef
29.
go back to reference Masi G, et al. Depressive comorbidity in children and adolescents with generalized anxiety disorder. Child Psychiatry Hum Dev. 2000;30(3):205–15.PubMedCrossRef Masi G, et al. Depressive comorbidity in children and adolescents with generalized anxiety disorder. Child Psychiatry Hum Dev. 2000;30(3):205–15.PubMedCrossRef
30.
go back to reference Varchol L, Cooper H. Psychotherapy approaches for adolescents with eating disorders. Curr Opin Pediatr. 2009;21(4):457–64.PubMedCrossRef Varchol L, Cooper H. Psychotherapy approaches for adolescents with eating disorders. Curr Opin Pediatr. 2009;21(4):457–64.PubMedCrossRef
31.
go back to reference Lakhdir MPA, et al. Factors associated with child maltreatment among children aged 11 to 17 years in community settings of Karachi, Pakistan, using Belsky Ecological Framework. J Interpersonal Violence. 2017;36:297–313.CrossRef Lakhdir MPA, et al. Factors associated with child maltreatment among children aged 11 to 17 years in community settings of Karachi, Pakistan, using Belsky Ecological Framework. J Interpersonal Violence. 2017;36:297–313.CrossRef
32.
go back to reference Birmaher B, et al. The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry. 1997;36(4):545–53.PubMedCrossRef Birmaher B, et al. The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry. 1997;36(4):545–53.PubMedCrossRef
33.
go back to reference Joshi A, et al. Frequency and types of anxiety-related emotional disorders in secondary school children in an urban population from India. German J Psychiatry. 2013;16:112–8. Joshi A, et al. Frequency and types of anxiety-related emotional disorders in secondary school children in an urban population from India. German J Psychiatry. 2013;16:112–8.
34.
go back to reference Jastrowski Mano KE, et al. The psychometric properties of the screen for child anxiety related emotional disorders in pediatric chronic pain. J Pediatr Psychol. 2012;37(9):999–1011.PubMedCrossRef Jastrowski Mano KE, et al. The psychometric properties of the screen for child anxiety related emotional disorders in pediatric chronic pain. J Pediatr Psychol. 2012;37(9):999–1011.PubMedCrossRef
35.
go back to reference Zolotor A, et al. ISPCAN Child Abuse Screening Tool Children’s version (ICAST-C): instrument development and multi-national pilot testing. Child Abuse Negl. 2009;33:833–41.PubMedCrossRef Zolotor A, et al. ISPCAN Child Abuse Screening Tool Children’s version (ICAST-C): instrument development and multi-national pilot testing. Child Abuse Negl. 2009;33:833–41.PubMedCrossRef
36.
go back to reference Cougle JR, et al. Examining the unique relationships between anxiety disorders and childhood physical and sexual abuse in the National Comorbidity Survey-Replication. Psychiatry Res. 2010;177(1–2):150–5.PubMedCrossRef Cougle JR, et al. Examining the unique relationships between anxiety disorders and childhood physical and sexual abuse in the National Comorbidity Survey-Replication. Psychiatry Res. 2010;177(1–2):150–5.PubMedCrossRef
37.
38.
go back to reference Bowes L, et al. Sibling bullying and risk of depression, anxiety, and self-harm: a prospective cohort study. Pediatrics. 2014;134(4):e1032–9.PubMedCrossRef Bowes L, et al. Sibling bullying and risk of depression, anxiety, and self-harm: a prospective cohort study. Pediatrics. 2014;134(4):e1032–9.PubMedCrossRef
39.
go back to reference Bahrami F, Yousefi N. Females are more anxious than males: a metacognitive perspective. Iran J Psychiatry Behav Sci. 2011;5(2):83.PubMedPubMedCentral Bahrami F, Yousefi N. Females are more anxious than males: a metacognitive perspective. Iran J Psychiatry Behav Sci. 2011;5(2):83.PubMedPubMedCentral
40.
go back to reference Vesga-López O, et al. Gender differences in generalized anxiety disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). J Clin Psychiatry. 2008;69(10):1606–16.PubMedPubMedCentralCrossRef Vesga-López O, et al. Gender differences in generalized anxiety disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). J Clin Psychiatry. 2008;69(10):1606–16.PubMedPubMedCentralCrossRef
41.
go back to reference Shear MK. Anxiety disorders in women: gender-related modulation of neurobiology and behavior. in Seminars in reproductive endocrinology. 1997. Copyright© 1997 by Thieme Medical Publishers, Inc. Shear MK. Anxiety disorders in women: gender-related modulation of neurobiology and behavior. in Seminars in reproductive endocrinology. 1997. Copyright© 1997 by Thieme Medical Publishers, Inc.
42.
go back to reference Pujol J, et al. Anatomical variability of the anterior cingulate gyrus and basic dimensions of human personality. Neuroimage. 2002;15(4):847–55.PubMedCrossRef Pujol J, et al. Anatomical variability of the anterior cingulate gyrus and basic dimensions of human personality. Neuroimage. 2002;15(4):847–55.PubMedCrossRef
43.
go back to reference Moffitt TE, et al. Generalized anxiety disorder and depression: childhood risk factors in a birth cohort followed to age 32. Psychol Med. 2007;37(3):441–52.PubMedCrossRef Moffitt TE, et al. Generalized anxiety disorder and depression: childhood risk factors in a birth cohort followed to age 32. Psychol Med. 2007;37(3):441–52.PubMedCrossRef
44.
go back to reference Pelcovitz D, et al. Psychiatric disorders in adolescents exposed to domestic violence and physical abuse. Am J Orthopsychiatry. 2000;70(3):360–9.PubMedCrossRef Pelcovitz D, et al. Psychiatric disorders in adolescents exposed to domestic violence and physical abuse. Am J Orthopsychiatry. 2000;70(3):360–9.PubMedCrossRef
45.
go back to reference MacMillan HL, et al. Childhood abuse and lifetime psychopathology in a community sample. Am J Psychiatry. 2001;158(11):1878–83.PubMedCrossRef MacMillan HL, et al. Childhood abuse and lifetime psychopathology in a community sample. Am J Psychiatry. 2001;158(11):1878–83.PubMedCrossRef
46.
go back to reference Khosravan SP, et al. The effect of education on the attitude and child abuse behaviors of mothers with 3–6 year old children: a randomized controlled trial study. Int J Commun Based Nurs Midwifery. 2018;6(3):227–38. Khosravan SP, et al. The effect of education on the attitude and child abuse behaviors of mothers with 3–6 year old children: a randomized controlled trial study. Int J Commun Based Nurs Midwifery. 2018;6(3):227–38.
Metadata
Title
Longitudinal association between parental-to-child-Maltreatment and self-reported Generalized Anxiety Disorder symptoms in Pakistani Adolescents
Authors
Maryam Pyar Ali Lakhdir
Ghazal Peerwani
Salman Muhammad Soomar
Apsara Ali Nathwani
Salima Farooq
Naureen Akber Ali
Asif Khaliq
Muhammad Masood Kadir
Syed Iqbal Azam
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Child and Adolescent Psychiatry and Mental Health / Issue 1/2021
Electronic ISSN: 1753-2000
DOI
https://doi.org/10.1186/s13034-021-00387-1

Other articles of this Issue 1/2021

Child and Adolescent Psychiatry and Mental Health 1/2021 Go to the issue