Anxiety in families: Exploring the causes

Anxiety in families: Exploring the causes

As a Research Associate at King’s College London, my work is focused on trying to understand how anxiety and other common forms of emotional problems run in families.

When I tell people this, they often say: “you need to look at my family!”.

It’s not surprising to hear that many people can identify intergenerational patterns (i.e., similarities between parents and children) of mental health problems in their families. Anxiety and related emotional problems constitute the most common forms of psychiatric impairment worldwide, and the children of parents who experience these problems are at higher risk for experiencing the same.

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But how does this intergenerational transmission happen? Was there something in the way your parents brought you up?

My PhD thesis was dedicated to this question. Specifically, I focussed on efforts to disentangle the role of genetic from social transmission in families. We know that all mental health problems are influenced to some extent by genetics. We also know that children inherit their DNA from their biological parents. So, the genetic variants (i.e., DNA differences identified across people) influencing emotional problems in parents could be the same genetic variants influencing emotional problems in their offspring. That is, parents and children can be similar to one another in part because they share the same genes.

However, genetics only explains part of the picture. Once we account for the role of genetics in families, then we can start to better understand what is going on in terms of social transmission (i.e., the result of direct interactions between parents and children). Here, it is important to recognise that social transmission is a two-way process. We often think about the ways in which parents can influence their children, but we must also remember to think about the ways in which children can influence their parents.

There has been a wealth of research to show that parents and children are similar in their mental health. There has been less research that allows us to isolate the role of genetics and to determine the direction of social effects between parents and children. To really get to grips with what we do and don’t know, I conducted a systematic literature review (i.e., where you systematically search through literature databases for every single piece of research that addresses your research question) and a meta-analysis (i.e., where you collect all the results that exist already and merge them together to get an overall result).

In collaboration with colleagues, I searched for published research that explored the association between parent anxiety and child emotional problems, while accounting for the influence of genetics.

Evidence suggests that mothers who experience anxiety during pregnancy do not pass on similar emotional problems to their children, but later exposure to an anxious parent might have an impact.

I found only eight studies on the association between parental anxiety and emotional problems in children. As specified by my search parameters, all these studies included techniques to account for and remove the role of genetics in how emotional problems can be passed on. These techniques involve comparing the likeness of family members who are differently related and/or exposed to one another (e.g., in adoptive families, where children are genetically unrelated to their rearing parents, any similarities between parents and children must be attributable to environmental effects).

The studies that I found were all derived from Europe and the USA, published between 2010 and 2019. The first thing to note is that this is a very small literature base, from a very narrow sample of people, relative to the global population. This means that we have limited information on how well findings would generalise across different populations (i.e., across cultures, environments and societies).

Data from three studies (which assessed >11,700 families with children aged 0.5 to 10 years) showed that exposure to mothers’ anxiety during pregnancy was not associated with emotional problems in children, after the effects of genetics on this association were accounted for and removed. In other words, there was no evidence to suggest that mothers’ anxiety during pregnancy increased the child’s risk for developing emotional problems. The association between mothers’ anxiety during pregnancy and child emotional problems was explained by their genetic relatedness.

Meanwhile, six studies (which assessed >12,700 families with children aged 0.75 to 22 years) on parents’ anxiety after birth found a small association with emotional problems in children, after accounting for the role of genetics. This means that exposure to an anxious parent after birth might have an impact on child emotional problems, over and above the role of genetics. However, it wasn’t possible to tell whether this impact was parent or child driven (i.e., parents influencing children and/or children influencing parents), nor whether this effect would be long-lasting across time. So, although social exposure to your parent or child’s emotional problems could affect your own symptoms, we can’t say whether this effect is likely to stick around.

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When I tell people what I’ve been working on, and they want to know what it means for their families… what should I say?

Our findings should be reassuring for parents. For pregnant mothers, we suggest that anxiety symptoms during pregnancy do not cause an increased risk of anxiety in the foetus. After birth, for parents of children and adolescents, our findings do not point to any large effects of parent anxiety on child emotional problems.

There are three important points to consider:

First, there is a striking need for new research. We are asking an important question about a topic that touches many people’s lives — how emotional problems run in families. But only eight studies have used robust methods for identifying the genetic and environmental pathways that exist in general populations. It is important that new research is conducted in this area, to help us develop better ways of preventing and supporting mental health from an early age.

Second, we are not going to find a single cause. We cannot place all the ‘blame’ on our parents, just as we can’t solely ‘blame’ our genes or our wider environments (and I note here that wider environmental influence is not something we looked at in the research I described above — but could involve factors relating to wealth, pollution or crime levels, access to education and healthcare). The majority of existing literature focuses on mother-child relationships. Future research should take a more holistic view, considering the role of fathers, as well as siblings and broader environments.

Third, a significant limitation across all mental health research is that it is conducted predominantly in Northern Europe and America, with participants who identify as white. In these areas, we have extremely limited information on the lived experiences of people from marginalised racial and ethnic groups, as well as those living elsewhere across the globe. Until this imbalance is addressed, mainstream evidence in mental health research will continue to perpetuate a cycle of evidence-based policy that excludes people who are not of white, European ancestry (i.e., excluding the global majority). We do not yet know whether our findings would hold true across different groups in different contexts, environments, and cultures.