title: Childhood anxiety: an early predictor of mood disorders in offspring of bipolar parents.
abstract: BACKGROUND
  Anxiety disorders are common among the offspring of parents with bipolar disorder (BD). This study investigated the nature of the association between anxiety disorders and mood disorders in a prospectively studied high-risk cohort.
  
  
  METHODS
  High-risk offspring were identified from families in which one parent had confirmed BD based on SADS-L interviews and best estimate diagnostic procedures. All agreeable offspring aged 8-25 years were enrolled in a longitudinal study involving repeated KSADS-PL format clinical assessments. Control (C) offspring from families in which neither parent met lifetime criteria for a psychiatric disorder were similarly assessed. All DSM-IV diagnoses in the offspring were confirmed on blind consensus review. Cumulative incidence and adjusted Cox Proportional Hazards models were used to calculate the risk of anxiety disorders and the predictive association with mood disorders.
  
  
  RESULTS
  The cumulative incidence of anxiety disorders was higher (23.40% vs. 10.42%; HR=2.136; p=.0382) and occurred earlier (9.79 vs. 14.84 years; p=.0125) in high-risk compared to C offspring. In high-risk offspring generalized anxiety disorders (GAD) followed by social phobia were the most incident anxiety subtypes; while high emotionality (HR 1.111; p=.0096) and shyness (HR 1.144; p=.0053) increased the risk of anxiety disorders. Anxiety disorders increased the adjusted risk of mood disorders (HR 2.166; p=.0004), on average 8.49 years later (SD 5.97).
  
  
  CONCLUSIONS
  The cumulative incidence of BD is relatively low, as the cohort is still in the period of risk.
  
  
  CONCLUSIONS
  Findings highlight the need for longitudinal surveillance of symptomatic high-risk children and suggest anxiety disorders are an important early intervention target.
authors.affiliation: Hotchkiss Brain Institute & Department of Psychiatry, University of Calgary, Calgary, AB, Canada T2N 4Z6. acduffy@ucalgary.ca
authors.forename: Anne
authors.initials: A
authors.lastname: Duffy
authors.forename: Julie
authors.initials: J
authors.lastname: Horrocks
authors.forename: Sarah
authors.initials: S
authors.lastname: Doucette
authors.forename: Charles
authors.initials: C
authors.lastname: Keown-Stoneman
authors.forename: Shannon
authors.initials: S
authors.lastname: McCloskey
authors.forename: Paul
authors.initials: P
authors.lastname: Grof
mesh_terms: D000293:Adolescent; D001007:Anxiety; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology*; D001714:Bipolar Disorder / Q000523:psychology*; D016022:Case-Control Studies; D002648:Child; D016241:Child of Impaired Parents / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D019964:Mood Disorders / Q000453:epidemiology / Q000523:psychology*; D010290:Parents / Q000523:psychology; D012306:Risk; D055815:Young Adult
keywords: Anxiety disorder; Bipolar disorder; Clinical course; Genetics; High-risk offspring; Mood disorders