Depression and anxiety among parents of phenylketonuria children

Objective:

To investigate the existence of depression and/or anxiety with underlying risk factors among parents of children with classical phenylketonuria (PKU).

Methods:

This cross-sectional study was conducted in the Division of Pediatric Metabolism, Ankara Children’s Hospital, Dokuz Eylul University, Kırıkkale University, and Erzurum Local Research Hospital, Turkey, between January and July 2014. Parents of 61 patients and 36 healthy controls completed the self-report questionnaires. We used Beck Depression Inventory (BDI) to assess the parental depression and State-Trait Anxiety Inventory S-T (STAI S-T) to assess parental anxiety.

Results:

Depression and anxiety scores were significantly higher in the case group (BDI 12.3±9.1; STAI-S: 38.2±9.6; STAI-T: 43.2±6.9) than controls (BDI: 5.4±4.1 p=0.000; STAI-S: 31.8±7.6 p=0.001; STAI-T: 37.0±7.2 p=0.000). Mothers of the patients had higher scores than the other parental groups (BDI: p=0.000, STAI-S: p=0.001 and STAI-T: p=0.000). Logistic regression analysis showed that low educational level of the parent was the only independent factor for depression (OR 9.96, 95% CI: 1.89-52.35, p=0.007) and state anxiety (OR: 6.99, 95% CI: 1.22-40.48, p=0.030) in the case group.

Conclusion:

A subset of parents with PKU patients have an anxiety or depressive disorder. Supportive services dealing with the parents of chronically ill children such as PKU are needed in order to reduce the level of anxiety.Phenylketonuria (PKU, OMIM: 261600) is an autosomal recessive disorder caused by hepatic phenylalanine hydroxylase enzyme (EC 1.14.16.1) deficiency. Phenylketonuria is the most prevalent inborn error of amino acid metabolism in the world. There is a nationwide newborn screening program in Turkey since 2007 for this disease. If PKU is not diagnosed at birth and dietary treatment was not started, it can cause severe irreversible mental deterioration. Treatment of classical PKU depends on life-long phenylalanine (Phe) restricted diet with supplementation of Phe-free amino acid mixtures to maintain therapeutic blood Phe levels and adequate nutrition. Several studies showed that discontinuation of the therapy or diminished compliance to this strict diet resulted in neuropsychological problems as well as decline in intelligence quotient (IQ), even though the diet was started during the neonatal period.1-3Successful treatment of classical PKU, like other disorders of inborn errors of metabolism (IEM), requires a team effort including physicians with other health workers, particularly patients and their parents.4,5 Parents have to supervise and evaluate the daily nutritional intake of their child continously.6 The major problem encountered in the treatment of PKU in developing countries is the lack of dietary adherence, which is due to limited number of experienced clinics, large families, ignorance of the parents, financial limitations, low risk perceptions of the parents, difficulties in the supply of low-protein products.7-9As in PKU, diet-related diseases such as diabetes, celiac disease, food allergies, cystic fibrosis, and other inherited metabolic diseases were shown to be associated with the increased risk of anxiety and depression both in patients10,11 and their families due to the decreased quality of life within the household.11-14 Decreased quality of life and presence of mood disorders in PKU patients has been largely investigated in different studies.15-17 However, there are few studies investigating mood disorders in parents of PKU patients in the literature.6,12,18 Caring for a chronically ill child with or without disabilities at home might be somewhat disconcerting for the caregivers. The development of interventions to reduce the stress experienced by caregivers is necessary for the success of the dietary treatment of PKU patients. Determination of predictors of depression and anxiety among parents caring for PKU children may help health professionals in identifying those parents who need special attention to restore their psychological well-being. The objective of this study was to investigate the existence and severity of depression and anxiety in parents of children with classical PKU and to evaluate the relationship between mood disorders and possible risk factors in those parents.     

The co-occurrence of anxiety disorders in African American parents and their children

This study examined the co-occurrence of anxiety disorders, specifically the relationship between parent and youth anxiety, in a community-based sample of 100 African American parents and their biological child between the ages of 6 and 17 years. Data were provided by both the parent and child. Parents completed the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) Client Version about their own experiences with anxiety and related disorders and the Parent version for the child's experiences. Children were administered the ADIS-IV Child version to assess their experiences with anxiety and related disorders. Fifty-five parents met criteria for at least one anxiety disorder while 34 children met criteria for at least one anxiety disorder. Two logistic regressions were subsequently conducted to predict the presence of any form of psychopathology from the ADIS-IV and the presence of an anxiety disorder in African American offspring. Results indicated that African American offspring with an anxious parent were 4 times more likely to meet criteria for both an anxiety disorder and other forms of psychopathology.     

Depression,anxiety and quality of life in parents of children with epilepsy

0bjectives – To assess the impact of childhood epilepsy on parental quality of life (QOL) and psychological health, and to investigate possible correlations between parental QOL and background variables as well as parental anxiety and depression. Subjects and methods – Parents having an epileptic child (n = 263) and parents having a healthy child (n = 270) were enrolled. Groups were in balance for background variables. Short‐Form Health Survey (SF‐36) Questionnaire, Zung Depression Scale (ZDS) and Zung Anxiety Scale (ZAS) were applied to all parents. Patients were divided into the first visit group (newly diagnosed epilepsy) and follow‐up visit group. Results – The parents of children with epilepsy had significantly lower QOL scores in SF‐36 for all subscales and higher levels of depression and anxiety by using ZDS and ZAS. The factors correlated with parental QOL were seizure control, visit status, anxiety, depression, employment, cost of epilepsy, status epilepticus, drug side effect and age of parents. Conclusions – Childhood epilepsy has a severe impact on parental QOL and psychological health, and recognition of possible correlations between parental QOL and background variables will be helpful to improve parental QOL.     

Anxiety sensitivity among children of parents with anxiety disorders: a controlled high-risk study

We investigated whether parental anxiety was related to anxiety sensitivity (AS) in offspring. Subjects were 261 offspring (aged 6-17 years) of parents with lifetime DSM-IV anxiety and/or mood disorders, and 79 offspring of parents with no lifetime anxiety, mood, or psychotic disorder. Parents and offspring were interviewed by blind clinicians. Children were administered the Child Anxiety Sensitivity Index (CASI). There were no significant differences between CASI scores of the offspring of parents with anxiety and/or mood disorders, and offspring of comparison parents. We conclude that parental anxiety or mood disorder does not predispose offspring to high anxiety sensitivity.     

Multiple informant agreement and the anxiety disorders interview schedule for parents and children

OBJECTIVE: To examine concordance of child, parent, and consensus agreement on the Anxiety Disorders Interview Schedule, Child and Parent versions (ADIS-C/P), for an outpatient sample of children and adolescents and to explore moderators of those relations. Child characteristics (age, gender, social desirability), a family environment variable (conflict), and type of diagnoses (internalizing, externalizing) were systematically examined. METHOD: These relations were examined in 165 children and adolescents referred to a psychological clinic by family practitioners, pediatricians, schools, and mental health professionals. Participants were individually administered the ADIS-C or ADIS-P by separate clinicians, and consensus diagnoses were determined in a clinical conference. Agreements between child-parent, child-consensus, and parent-consensus were determined. RESULTS: Poor levels of agreement were found among our informants, especially between child and parent and to some extent between child and consensus. Agreement was higher between parent and consensus, suggesting that our clinicians tended to favor parent input over child input. Although the effects were complex, characteristics of the child, family, and type of diagnosis moderated or qualified these findings. CONCLUSIONS: Although discrepancies exist among our informants, our overall findings suggest important information is obtained from each informant and, when combined with certain modifying characteristics, may lead to diagnostic and treatment decisions.     

Stability of prevalence. Depression and anxiety disorders

Information about point prevalence of depression and anxiety disorders from two cross-sectional surveys in Stirling County (Canada) indicates that an overall prevalence rate of 12.5% characterized a year close to midcentury and a prevalence rate of 12.7% characterized another year toward the end of the century's third quarter. The stability of the prevalence rates contrasts sharply with the fact that numerous social changes took place over this period of time in this place of study. There were, however, small trends in the distribution of depression and anxiety by sex and age, especially an increased similarity in the overall rates for men and women in the age range of 40 to 69 years. Hypotheses are offered about social circumstances that may have influenced the diminishing difference between the sexes.     

Depression and anxiety disorders in pediatric epilepsy

PURPOSE: This study examined affective disorders, anxiety disorders, and suicidality in children with epilepsy and their association with seizure-related, cognitive, linguistic, family history, social competence, and demographic variables. METHODS: A structured psychiatric interview, mood self-report scales, as well as cognitive and language testing were administered to 100 children with complex partial seizures (CPSs), 71 children with childhood absence epilepsy (CAE), and 93 normal children, aged 5 to 16 years. Parents provided behavioral information on each child through a structured psychiatric interview and behavior checklist. RESULTS: Significantly more patients had affective and anxiety disorder diagnoses (33%) as well as suicidal ideation (20%) than did the normal group, but none had made a suicide attempt. Anxiety disorder was the most frequent diagnosis among the patients with a diagnosis of affective or anxiety disorders, and combined affective/anxiety and disruptive disorder diagnoses, in those with suicidal ideation. Only 33% received some form of mental health service. Age, verbal IQ, school problems, and seizure type were related to the presence of a diagnosis of affective or anxiety disorder, and duration of illness, to suicidal ideation. CONCLUSIONS: These findings together with the high rate of unmet mental health underscore the importance of early detection and treatment of anxiety disorders and suicidal ideation children with CPSs and CAE.     

Depression, anxiety and neurotic disorders

The author establishes reports between humoral disorders and anxiety disorders. The relative use of benzodiazepines in the treatment of depressive states is analyzed and a simple drug treatment schedule is proposed.     

Dimensional assessment of anxiety disorders in parents and children for DSM‐5

The current shift in the DSM towards the inclusion of a dimensional component allows clinicians and researchers to demonstrate not only the presence or absence of psychopathology in an individual, but also the degree to which the disorder and its symptoms are manifested. This study evaluated the psychometric properties and utility of a set of brief dimensional scales that assess DSM‐based core features of anxiety disorders, for children and their parents. The dimensional scales and the Screen for Child Anxiety Related Emotional Disorders (SCARED‐71), a questionnaire to assess symptoms of all anxiety disorders, were administered to a community sample of children (n = 382), aged 8–13 years, and their mothers (n = 285) and fathers (n = 255). The dimensional scales assess six anxiety disorders: specific phobia, agoraphobia, panic disorder, social anxiety disorder, generalized anxiety disorder, and separation anxiety disorder. Children rated their own anxiety and parents their child's anxiety. The dimensional scales demonstrated high internal consistency (α > 0.78, except for father reported child panic disorder, for reason of lack of variation), and moderate to high levels of convergent validity (r _s = 0.29–0.73). Children who exceeded the SCARED cutoffs scored higher on the dimensional scales than those who did not, providing preliminary support for the clinical sensitivity of the scales. Given their strong psychometric properties and utility for both child and parent report, addition of the dimensional scales to the DSM‐5 might be an effective way to incorporate dimensional measurement into the categorical DSM‐5 assessment of anxiety disorders in children. Copyright © 2014 American Psychiatric Association. All rights reserved.     

Depression and anxiety disorders in children and adolescents with velo-cardio-facial syndrome (VCFS)

Velo-cardio-facial syndrome (VCFS) is characterized by a high prevalence of depression and anxiety disorders in childhood and adolescence. These disorders are a source of great impairment in everyday functioning, as well as important risk factors for the emergence of later psychotic disorders. Impairment in daily and social functioning as well as loss of IQ throughout growth are also are well-established correlates of the VCFS. This study aimed to confirm the high prevalence of depression and anxiety disorders. The second objective was to ascertain the correlation between anxious and depressive symptoms and the decline in adaptive and cognitive functioning. A total of 73 children and adolescents with VCFS (mean age 11.9 years) underwent psychiatric evaluation. Subjects were further divided into four age groups: ages 6-9, 9-12, 12-15 and 15-18 years. Assessments measuring intelligence, anxious and depressive symptoms, and adaptation skills reported by parents were submitted to a subsample of 62 children (mean age 12.2 years); 62.2 % of the sample showed an anxiety disorder, specific phobia being the most represented at all ages. Lifetime depression concerned 27 % of the sample, peaking at age 12-15 years. Anxious and depressive symptoms and low IQ were significantly associated with low adaptive functioning. Anxiety and depression are common disorders in children and adolescents with VCFS and have a great impact on adaptive functioning. Clinicians should pay great attention to diagnosis and treatment.     

Personality disorders in offspring of mothers with mood disorders: Results from a longitudinal family study

Offspring of mothers with mood disorders are known to be at risk for a range of adverse outcomes, but the prevalence of personality disorders (PDs) in this group is unknown. The goal of this study was to assess risk of PD diagnoses and symptoms in offspring of mothers with and without mood disorders, and to explore contributing factors to this risk. This longitudinal study assessed PDs and symptoms of PDs in offspring of mothers with bipolar disorder (O-BD), major depression (O-MDD), and no psychiatric diagnosis (O-WELL) in mid-adolescence and in early adulthood. O-BD were more likely to develop a Cluster B PD than O-MDD or O-WELL in adolescence, and more likely to develop a Cluster B PD then O-WELL in early adulthood. Dimensional analyses revealed that O-BD had elevated symptoms in PDs across all PD clusters at mid-adolescence and young adulthood. O-MDD showed elevated symptoms of antisocial PD at both time points, and of obsessive-compulsive PD at young adulthood. Offspring of mothers with mood disorders, especially O-BD, are at increased risk for PD diagnoses and symptoms in mid-adolescence and early adulthood. Contributing factors to risk of PD symptoms in at-risk offspring are discussed.     

Cycloid psychoses as atypical manic-depressive disorders. Results of a family study

BACKGROUND: Whereas a growing body of evidence suggests that cycloid psychoses have to be separated from schizophrenic psychoses, their relations to bipolar affective disorder are less clear. PATIENTS AND METHODS: In a controlled family study, we recruited 46 patients with cycloid psychosis (CP), 33 with manic-depressive illness (MDI), and 27 controls. Three hundred fifty-six of 389 living first-degree relatives were personally examined by experienced psychiatrists blinded to the diagnosis of the index proband. RESULTS: The relatives of CP patients showed significantly lower morbidity risk of functional psychoses than relatives of patients with MDI in Kaplan-Meier life table calculation. The morbidity risk for functional psychoses in relatives of patients with CP did not differ significantly from that in relatives of controls. CONCLUSION: These results suggest that CP are etiologically different from bipolar affective psychoses and cannot be integrated into the spectrum of bipolar affective disorders. The findings provide further evidence for a nosological independence of CP.     

Alcohol problems in adolescence with reference to high risk children of alcoholic parents. Results of a family study in Mecklenburg Vorpommern

In earlier studies, children of alcoholics (COAs) reported more alcohol and drug problems and higher levels of maladaptive behaviour and psychiatric distress than non-COAs. However, increased exposure to drugs and alcohol among COAs does not fully explain this phenomenon. In our family-based study design, we were able to investigate specific risk factors for alcohol problems in adolescence. In a first step, we compared a variety of psychosocial risk factors in 90 adolescents (12-18 years of age) from families with at least one alcohol-abusing parent with those of 90 adolescents of parents without alcohol disorders. In a second step, we investigated the meaning of all included risk factors for alcohol problems of the adolescents. Our results give some support to the existence of a lower extent of emotional warmth and support by parents of children in the COA sample. Moreover, males of the COA group reported more parental rejection and higher values on measures of attention problems and anxiety/depression than controls, whereas there were no such differences between females of the COA group and their control counterparts. Additionally, logistic regression analysis revealed that only the membership in a substance-using peer group and higher age are important risk factors for alcohol problems during adolescence. Considering our results, it is of great importance (a) to identify families at risk at the earliest possible stage and (b) to develop intervention and prevention programs further for parents and children to increase social competence and protect children at risk from later alcohol abuse.     

Further evidence of an association between behavioral inhibition and anxiety disorders: results from a family study of children from a non-clinical sample

Behavioral inhibition to the unfamiliar, identifiable in early childhood and reflecting the tendency to exhibit withdrawal and excessive autonomic arousal to challenge or novelty, has been found to be prevalent in young offspring of parents with panic disorder and agoraphobia and associated with risk for anxiety disorders in these children. Using family study methodology, we now examine psychopathology in first degree relatives of children from a non-clinical longitudinal cohort identified at 21 months of age as inhibited (N = 22) or uninhibited (N = 19) and followed through the age of seven years for a study of preservation of temperamental characteristics in normal children. These assessments were compared with evaluations of the first degree relatives of 20 normal comparison children. Psychiatric assessments of parents (N = 110) and siblings (N = 72) were based on structured interviews conducted blindly to the temperamental classification of the index child. Parents of inhibited children, compared with parents of uninhibited and normal controls, had significantly higher risks for multiple (greater than or equal to 2) anxiety disorders, continuing anxiety disorders (both a childhood and adulthood anxiety disorder in the same parent), social phobia, and childhood avoidant and overanxious disorders. These findings provide additional support for the hypothesis linking behavioral inhibition with risk for anxiety disorder.     

The treatment of anxiety disorders in children and adolescents.

Anxiety disorders are the most common psychiatric conditions in the pediatric population, with prevalence estimates ranging from 5-18%. Children and adolescents with excessive anxiety often meet diagnostic criteria for a number of disorders within the DSM-IV. Unfortunately, the current diagnostic system is controversial because of high rates of symptom overlap, comorbidity with other psychiatric disorders, and lack of biological markers that would support a more empirical anxiety nosology. Treatment strategies for pediatric anxiety disorders have important historical roots. Several controlled studies of cognitive-behavioral therapy (CBT) demonstrate efficacy for pediatric anxiety disorders. In contrast, no controlled psychopharmacology studies have demonstrated efficacy in children and adolescents with anxiety disorders, except obsessive-compulsive disorder; however, several large, methodologically sound psychopharmacotherapy trials are underway for pediatric anxiety disorders. This update will review the current status of psychosocial and psychopharmacologic treatment of pediatric anxiety disorders. In addition, a brief discussion of nosology, epidemiology, and developmental course of anxiety is included. Preliminary psychopharmacology treatment and CBT treatment algorithms are presented for pediatric anxiety disorders, based on the best available data. Recommendations for future research directions are also discussed.     

Chronic course of anxiety disorders in children and adolescents.

In a naturalistic study that assessed the lifetime psychiatric histories of 275 children ascertained independently of diagnostic or treatment-seeking behavior, 38 (14%) of the children had a history of anxiety disorder. Rates of comorbidity of depression and other psychiatric disorders were high. Life table estimates of the duration of illness indicate a more protracted time to recover than expected, because 46% would be ill for at least 8 years. Moreover, of those who recovered from their first episode of anxiety disorder, many had experienced recurrence before interview. After conducting pooled analyses, investigators performed separate analyses for children with separation disorder and overanxious disorder. Median age of onset of these conditions was surprisingly young: 10 years of age for overanxious disorder and 8 years of age for separation disorders.