Publication year
2014
Citation Title
Longitudinal patterns of anxiety from childhood to adulthood: The Great Smoky Mountains Study.
Journal Name
Journal of the American Academy of Child and Adolescent Psychiatry
Journal Volume
53
Issue Number
1
Page Numbers
21-33
DOI
10.1016/j.jaac.2013.09.017
Summary
Participants from 11 rural counties in western North Carolina participated in a prospective longitudinal study aimed at characterizing developmental patterns, prevalence, and comorbidity of childhood anxiety disorders and their relationships to adult functioning. Results suggest that anxiety disorders are common, that the prevalence of various anxiety disorders differs with age, and that childhood anxiety is associated with adulthood maladaptation.
Key Findings
The prevalence rate of having at least one anxiety disorder diagnosis followed a U-shape, with the highest rates in early childhood and adulthood and a sharp decline in middle childhood.
Among the sample, separation anxiety disorder was common in childhood; panic disorder, agoraphobia, and generalized anxiety disorder were common in adulthood.
All childhood anxiety disorders were associated with adverse functioning in at least one adulthood domain. Generalized anxiety disorder and overanxious disorder were associated with poor functioning across all adult domains.
Implications for Military Professionals
Collaborate with organizations connected with military parents to emphasize the importance of programming that discusses children's mental health for all families
Collaborate with social service professionals about ways in which to facilitate program activities that provide the most engagement for children and adolescents with mental health concerns
Implications for Program Leaders
Educate military parents about childhood anxiety in order to assist with early detection and appropriate referrals
Create curricula and activities which assist children in military families who manage anxiety disorders to develop healthy coping strategies
Implications for Policy Makers
Recommend programs engaged in routine outreach to military family members about mental health concerns to increase access to mental health services
Encourage collaborations between installations and mental health organizations to raise awareness and combat stigma surrounding mental health
Methods
A screening-stratified sampling design was used to identify participants based on a telephone screening of a random sample of children in the study area using a household equal probability design.
Participants and a parent completed annual assessments up to age 16 years with additional follow-ups every few years up to age 26 years.
Attrition was low in that 98% of youth provided more than one assessment, and approximately 80% of participants contributed at least six assessments.
Participants completed interviews to evaluate anxiety disorders at each time point. Adult outcomes including health, educational/financial functioning, and social functioning, and were evaluated at ages 19, 21, and 24-26 years.
Participants
One thousand four hundred twenty children ages 9, 11, and 13 years (and a parent) participated in this study at baseline.
Fifty-one percent of the youth were female and 34% of the families fell below the poverty line.
The racial composition of the children and adolescents were 89% White, 7% Black, and 4% Native American.
Limitations
Anxiety disorder status was based on interview data collected by bachelor’s level research assistants. Although they received one month of training and quality control, diagnostic accuracy is questionable.
Participants were primarily White children from rural counties in one state where more than one third of the sample fell below the poverty line; therefore, the findings may not generalize to the broader population.
Assessments were focused on a three month period; because, the other nine months were not evaluated, the prevalence rates reported may underestimate the true prevalence of anxiety disorders.
Avenues for Future Research
Replicate the study that includes data on younger children to better capture the course of childhood anxiety disorders (e.g., separation anxiety)
Gather similar data from more geographically and demographically diverse samples
Examine the effectiveness of interventions aimed at reducing anxiety disorders among children and adolescents in military families
Focus
Civilian
Target Population
Population Focus
Abstract
Objective: The aims of this study were 2-fold: to provide a brief introduction to the prospective longitudinal Great Smoky Mountains Study and review recent findings; and to use this sample to conduct an epidemiologic analysis of common childhood anxiety disorders. Method: The population-based Great Smoky Mountains Study assessed 1,420 participants from 11 counties in the southeastern United States up to 11 times between ages 9 and 26 years with the structured Child and Adolescent Psychiatric Assessment and its upward extension, the Young Adult Psychiatric Assessment. Results: The U-shaped age prevalence curve for any anxiety disorder was the product of high levels of childhood separation anxiety and adult panic, agoraphobia, and generalized anxiety. More than 1 in 5 subjects met criteria for an anxiety disorder by early adulthood. In terms of cumulative comorbidity, there was evidence of overlap between anxiety disorders, but the level of overlap was generally consistent with what is seen among other common childhood disorders. All childhood anxiety disorders were associated with adverse functioning in at least 1 young adult functional domain, with the poorest outcomes for childhood generalized anxiety and DSM-III-R overanxious disorder. Conclusion: Clinically significant anxiety is a common mental health problem to have had by adulthood. There was little evidence to support the consolidation of anxiety disorders, and some evidence to justify reintroduction of DSM-III-R overanxious disorder. The transition to young adulthood appears to be a key period for understanding the development of common adult anxiety disorders such as panic and agoraphobia.
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