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Prediction of clinical anxious and depressive problems in mid childhood amongst temperamentally inhibited preschool children: a population study

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Abstract

Shy/inhibited young children are at risk for internalising difficulties; however, for many, this temperamental style does not result in mental health problems. This study followed a population-based sample of temperamentally inhibited preschool children into mid childhood to explore the aetiology of clinical-level anxious and depressive problems. Amongst inhibited preschool children, we aimed to predict each of clinical child anxiety and depressive problems in mid childhood from a broad range of potential risks (demographics, traumatic events and broader recent stressors, parents’ well-being, and parenting practices). This study is based on data from a wider population trial of Cool Little Kids that recruited a representative sample of inhibited preschool children enrolled in their year before starting school. In 2011–2012, an inhibition screen was universally distributed to parents of children in their year before school (age 4 years) across eight diverse government areas in Melbourne, Australia. Participants were 545 parents of inhibited preschoolers (78% uptake, 545/703) who were followed to mid childhood (three annual waves 2015–2017, age 7–10 years) with 84% retention (456/545). Parents completed questionnaires spanning child ages 4–10 years, along with diagnostic interviews for child anxiety. Children also completed questionnaires in mid childhood. The questionnaires encompassed a variety of potential risks including sociodemographics, traumatic events, recent life stressors, parent wellbeing and parenting practices. In mid childhood, 57% (246/430) of inhibited preschoolers had a clinical level of anxiety problems while 22% (95/432) had depressive problems (by one or more sources). The aetiology analyses highlighted parent distress and parenting practices (overinvolved/protective, harsh discipline) as key predictors of inhibited preschoolers’ internalising problems by mid childhood. Some high-risk families may not have participated. Child depression was not assessed with a diagnostic interview. The measures did not include every possible risk factor. The findings lend support to parenting programs for shy/inhibited young children that aim to prevent the development of anxiety and depression as they grow.

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Notes

  1. It is not uncommon for ORs for continuous IVs to be small since they are the ORs associated with a 1-point increase on the IV measure’s scale [77].

  2. While family income was excluded from the multivariate regression model as a suppressor effect [78], parental education and neighbourhood disadvantage continued to capture socioeconomic status [79].

  3. The association between positive parenting and child anxiety indicates some conceptual overlap with overinvolved/protective parenting, which can take place in a warm/nurturing parent–child relationship [60].

  4. While main language at home other than English and father born outside of Australia/New Zealand were excluded from the regression model due to suppressor effects [78], mother country of birth tapped cultural diversity.

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Acknowledgements

We thank preschool services and families in the Victorian cities of Banyule, Boroondara, Frankston, Kingston, Knox, Maroondah, Whitehorse and Wyndham who took part in this research. This research was supported by Australian National Health and Medical Research Council (NHMRC) Project Grants 607302 and 1079956, and by the Victorian Government’s Operational Infrastructure Support Program. The funder had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

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Authors and Affiliations

  1. School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia

    Jordana K. Bayer, Amy Brown, Margaret Nelson-Lowe, Tamsyn Gilbertson, Kate Noone, Natalie Bischof, Cassima Beechey & Fenny Muliadi

  2. Murdoch Children’s Research Institute, Melbourne, Australia

    Jordana K. Bayer, Lesley Bretherton & Harriet Hiscock

  3. Department of Paediatrics, University of Melbourne, Melbourne, Australia

    Jordana K. Bayer, Lesley Bretherton & Harriet Hiscock

  4. Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia

    Luke A. Prendergast

  5. Royal Children’s Hospital, Melbourne, Australia

    Harriet Hiscock

  6. Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Australia

    Cathrine Mihalopoulos

  7. Centre for Emotional Health, Macquarie University, Sydney, Australia

    Ronald M. Rapee

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Contributions

JB took the leading role in designing the study and writing the grant that was funded by the Australian National Health and Medical Research Council (NHMRC). RR, LB, HH and CM contributed to the study design and grant preparation. JB, AB, MN-L, TG, KN, NB, CB and FM were involved in the acquisition of study data. LP did the statistical analysis in consultation with JB and RR. JB drafted the manuscript with critical revision from RR, LP, AB, LB, HH, MN-L, TG, KN, NB, CB, FM and CM. All authors have approved the final article. JB is the guarantor.

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All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Bayer, J.K., Prendergast, L.A., Brown, A. et al. Prediction of clinical anxious and depressive problems in mid childhood amongst temperamentally inhibited preschool children: a population study. Eur Child Adolesc Psychiatry 32, 267–281 (2023). https://doi.org/10.1007/s00787-021-01857-9

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