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Original Investigation
January 7, 2019

Association of Constellations of Parental Risk With Children’s Subsequent Anxiety and Depression: Findings From a HUNT Survey and Health Registry Study

Author Affiliations
  • 1The Norwegian Institute of Public Health, Oslo, Norway
  • 2The Norwegian Center for Addiction Research, University of Oslo, Oslo, Norway
  • 3Department of Psychology, University of Oslo, Oslo, Norway
JAMA Pediatr. Published online January 7, 2019. doi:10.1001/jamapediatrics.2018.4360
Key Points

Question  Are different constellations of early parental risk, characterized by drinking, mental health, and education, associated with children’s subsequent diagnoses or treatment of anxiety and/or depression?

Findings  In this study of linked HUNT survey data and health registry data including 8773 children from 6696 two-parent families, despite seemingly innocuous levels of some parental behaviors and characteristics, certain early risk constellations (such as low parental education as well as elevated drinking in both parents and elevated mental health symptoms in fathers) were associated with significant increases in the risk of subsequent anxiety and/or depression among children compared with children from no-risk families.

Meaning  Studies examining the associations of parental risks with children’s mental health should consider parental risk factors in combination with one another, even if they appear below clinically defined levels.

Abstract

Importance  The research focus on children of parents with alcohol use disorder has eclipsed the potentially wider-reaching detrimental effects of subclinical parental drinking, both alone and in combination with other parental risk factors.

Objective  To identify constellations of early parental risk characterized by variations in drinking, mental health, and education in both parents and examine their prospective associations with children’s contact with the health care system for anxiety and/or depression (ie, diagnoses or treatment).

Design, Setting, and Participants  This prospective study was based on linked survey and health registries data. The sample included 8773 children from 6696 two-parent families in Norway who participated in the Nord-Trøndelag Health Study (HUNT) survey in 1995 to 1997 or 2006 to 2008, when the children were aged 13 to 19 years. Data were analyzed from January to September 2018.

Exposures  Five constellations of early parental risks, characterized by variations in drinking frequencies and amounts, mental health, and education for both parents, as identified through latent profile analysis.

Main Outcomes and Measures  Children’s diagnoses or treatment of anxiety and/or depression from 2008 to 2016 were recorded in 3 health registries. The primary outcome was the total number of registries where participants presented (ranging from 0 to 3).

Results  Of the 8773 included children, 4404 (50.2%) were boys, and the mean (SD) age at the time of participation in the Nord-Trøndelag Health Study was 16.1 (1.8) years. Prevalence of anxiety and/or depression, as evidenced in at least 1 registry record, was 24.3% (2132 of 8773). Early parental risk profiles risks marked by (1) the lowest parental education (adjusted relative risk, 1.13; 95% CI, 1.01-1.25) and (2) elevated drinking in both parents and elevated mental health symptoms in fathers (adjusted relative risk, 1.52; 95% CI, 1.03-2.22) were associated with a significant increase in risk of anxiety and/or depression in children from those families compared with children from no-risk families.

Conclusions and Relevance  Studies seeking to understand prospective associations of parental drinking with children’s mental health need to consider additional risk factors in combination with one another as well as parental behaviors and characteristics below clinically defined levels. When accumulated at a family level, even seemingly innocuous characteristics contributed to meaningful increases in risk of anxiety and/or depression among children, potentially translating into poorer mental health outcomes for many young people.

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