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Original Article |

Parental Psychopathology, Parenting Styles, and the Risk of Social Phobia in Offspring:  A Prospective-Longitudinal Community Study FREE

Roselind Lieb, PhD; Hans-Ulrich Wittchen, PhD; Michael Höfler, DiplStat; Martina Fuetsch, Mag.Rer.Nat; Murray B. Stein, MD; Kathleen R. Merikangas, PhD
[+] Author Affiliations

From the Department of Clinical Psychology and Epidemiology, Max Planck Institute of Psychiatry, Munich, Germany (Drs Lieb and Wittchen, Mr Höfler and Ms Fuetsch); Department of Psychiatry, University of California at San Diego, La Jolla (Dr Stein); and the Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn (Dr Merikangas).


Arch Gen Psychiatry. 2000;57(9):859-866. doi:10.1001/archpsyc.57.9.859.
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Background  This article examines the associations between DSM-IV social phobia and parental psychopathology, parenting style, and characteristics of family functioning in a representative community sample of adolescents.

Methods  Findings are based on baseline and first follow-up data of 1047 adolescents aged 14 to 17 years at baseline (response rate, 74.3%), and independent diagnostic interviews with one of their parents. Diagnostic assessments in parents and adolescents were based on the DSM-IV algorithms of the Munich-Composite International Diagnostic Interview. Parenting style (rejection, emotional warmth, and overprotection) was assessed by the Questionnaire of Recalled Parental Rearing Behavior, and family functioning (problem solving, communication, roles, affective responsiveness, affective involvement, and behavioral control) was assessed by the McMaster Family Assessment Device.

Results  There was a strong association between parental social phobia and social phobia among offspring (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.6-13.5). Other forms of parental psychopathology also were associated with social phobia in adolescents (depression: OR, 3.6; 95% CI, 1.4-9.1; any anxiety disorder other than social phobia: OR, 3.5; 95% CI, 1.4-8.8; and any alcohol use disorder: OR, 3.0; 95% CI, 1.1-7.8). Parenting style, specifically parental overprotection (OR, 1.4; 95% CI, 1.0-1.9) and rejection (OR, 1.4; 95% CI, 1.1-1.9), was found to be associated with social phobia in respondents. Family functioning was not associated with respondents' social phobia.

Conclusions  Data suggest that parental psychopathology, particularly social phobia and depression, and perceived parenting style (overprotection and rejection) are both associated with the development of social phobia in youth.

Figures in this Article

SOCIAL PHOBIA has become recognized as a prevalent mental disorder that typically starts in adolescence and is associated with significant impairment in work and social functioning.112 Despite the growing body of research on the risk factors, course, clinical characteristics, and treatment, the key etiological or pathogenetic mechanisms of social phobia are largely unknown. Several risk factors have been proposed, including biological,1316 familial, and genetic10,12,1720; early temperament (eg, behavioral inhibition21,22); socialization patterns23,24; and psychological factors, ranging from behavioral conditioning25,26 to cognitive variables.2729 There is increasing evidence regarding the role of familial factors in the development of social phobia. Studies using both the family study and family history approach have found higher rates of social phobia in relatives of social phobic patients compared with relatives of controls.3037 Two studies suggest that familial social phobia might be particularly important in the development of the "generalized" subtype, a more severe form of social phobia that is characterized by fears in a broad range of social situations.34,35 Since most family studies have focused primarily on the familial aggregation of social phobia among adult relatives, there is little research on specific links between social phobia in parents and offspring. High-risk studies of anxiety36 and social phobia37 have revealed increased rates of social phobia in offspring.

Although most studies indicate that the family may play an important role in the development of social phobia, there is little empirical evidence regarding the nature of the familial link in terms of genetic influences (eg, heritable biological factors) and specific family environmental factors (eg, parenting styles). With respect to the latter, several studies have demonstrated that adults with anxiety disorders, especially social phobia, retrospectively rate their parents as rejective and/or overprotective. Both parenting characteristics, individually and in combination (described in the literature as "affectionless control"38), may result in offsprings' development of subsequent difficulties in interpersonal interactions and social situations.3944 It should be noted that neither the role of parental social phobia nor the relevance of parenting style as risk factors for the development of social phobia has yet been tested prospectively in a community sample.

Using data from a representative population sample, this article evaluates whether parental social phobia is associated with social phobia in offspring, examines whether such an association is specific to parental social phobia or whether the risk is also elevated among offspring with other parental psychopathology, explores whether the parent-offspring association is higher in the generalized subtype of social phobia, and evaluates whether specific parenting styles and family functioning dimensions increase the risk for social phobia in adolescents.

DESIGN

The data presented come from the Early Developmental Stages of Psychopathology Study (EDSP). The EDSP is designed as a prospective-longitudinal survey to collect data on the prevalence and incidence, familial and other risk factors, comorbidity, and course of mental disorders in a representative sample of 3021 subjects aged 14 to 24 years at baseline. This article is restricted to adolescent respondents aged 14 to 17 years at baseline. Detailed descriptions of the EDSP design and field procedures are reported elsewhere.45,46

COMMUNITY RESPONDENTS AND PARENTS

The EDSP builds on a random population sample from the 1994 government population registers of residents in metropolitan Munich, including the surrounding counties. Details about the sampling and representativeness of the sample, along with its sociodemographic characteristics, have been reported elsewhere.4548 The response rate for the study sample of the 14- to 17-year-olds at baseline was 74.3%. These subjects, who will be referred to as the "respondents" in this article, were reinvestigated approximately 20 months later (mean, 19.7 months; range, 15.0-25.6 months) (N = 1228), with a response rate of 88%. At baseline, most of the respondents were attending school (89%) and living with their parents (97.8%). About 10% were in job training. The majority were classified as belonging to the middle class (61.4%). Noteworthy changes in sociodemographic characteristics from baseline to follow-up were only found for school (follow-up: 71% attended school) and employment status (follow-up: 21% were in job training).

Independent diagnostic interviews were conducted with the parents of these repondents. Interested not only in familial psychopathology but also in respondents' early development, we primarily interviewed the respondents' mothers. Fathers were interviewed only if the mother was dead or not locatable. The parents of 1053 adolescents were interviewed directly (response rate: 86%; in 1026 cases the mother, in 27 cases the father). Nonresponse in parents was predominantly because of refusal to participate (12.9%), failure to contact parents (0.7%), and lack of time (0.5%).

Throughout the article, data were weighted by age, sex, geographic location, noncontact and nonresponse to match the distribution of the sampling frame.46Table 1 summarizes the weighted and unweighted numbers and percentages at baseline, first follow-up, and the parent survey for the study sample.

Table Graphic Jump LocationTable 1. Response Rates and Demographic Distribution of Adolescents Aged 14 to 17 Years at Baseline*
DIAGNOSTIC ASSESSMENT
Assessment of Respondents

Diagnostic assessments in the baseline and first follow-up investigation were based on the computer-assisted version of the Munich-Composite International Diagnostic Interview (M-CIDI49), a modified version of the World Health Organization (WHO) CIDI, version 1.2, supplemented by questions to cover DSM-IV50 and International Classification of Diseases, 10th Revision (ICD-10)51 criteria. A detailed discussion of the M-CIDI, its social phobia module, and how it differs from the WHO-CIDI and findings of its reliability and validity have been presented elsewhere.12,46,5254 The M-CIDI allows for the assessment of symptoms, syndromes, and diagnoses of 48 mental disorders, along with information about onset, duration, and clinical and psychosocial severity. It includes a separate family-history module to evaluate psychopathology in relatives of the respondents. In both assessments, interviews were administered by highly trained clinical interviewers. Most interviews were carried out in the homes of the respondents.

Assessment of Parents

Parents were independently assessed with the M-CIDI as well, thus providing direct diagnostic information (M-CIDI/DSM-IV criteria) for the interviewed parent. All interviews were conducted by clinical interviewers who were blind to the diagnostic findings of the respective respondents, and most interviews took place in the parents' homes. The parent M-CIDI was supplemented with 2 additional modules that provided detailed information about the respondents' perinatal, psychological, and somatic conditions in infancy and early childhood, and family history data for the noninterviewed parent and other family members of the respondent.55

ASSIGNMENT OF DIAGNOSES

For respondents, diagnostic findings are based exclusively on the M-CIDI/DSM-IV diagnostic algorithms.49 Diagnostic estimates for parents were obtained using all available diagnostic information from the 2 sources: the family history data obtained from the M-CIDI family-history module at baseline with the respondent as informant, and the M-CIDI of the parent investigation, which provided direct M-CIDI/DSM-IV diagnostic information for the interviewed parent and family-history data for the noninterviewed parent. Parental diagnostic estimates were derived by computer on the basis of a priori established diagnostic algorithms with 3 levels of diagnostic certainty: "definite," "probable," or "no" diagnosis. Parents met criteria for a definite diagnosis whenever diagnostic information for the respective disorder was reported by both sources of data (the respondent interview and the parent investigation). A probable diagnosis was assigned whenever diagnostic information was reported by only 1 source (respondent or parent), with 1 notable exception: if a directly interviewed parent met full M-CIDI/DSM-IV criteria for a disorder, a definite diagnosis was assigned irrespective of the adolescent's report.

Because of the reliance on mothers' reports, no sex-specific analyses were performed. Family history items in both the baseline respondent interview and the parent survey were designed taking the the Family History Research Diagnostic Criteria56 as a basic model. To obtain family history information about the same DSM-IV Axis I disorders that are in the M-CIDI, we used the stem questions from the full M-CIDI to assess the key symptoms for the DSM-IV diagnoses. Questions were also asked to determine if the index subject sought professional help because of the respective symptoms. The validity of the family history information has been investigated by comparing the family history information gathered from the adolescents about their mothers with the diagnostic information obtained by the mothers themselves in the direct parent survey. Comparable with other studies,5759 we found high specificity but rather low sensitivity of the family history information.

ASSESSMENT OF PARENTING STYLE AND FAMILY FUNCTIONING

Parenting style was assessed by the Questionnaire of Recalled Parental Rearing Behaviour (German version, FEE60), which assesses the subject's (in our study, the adolescent's) perceived parental rearing behavior. It is composed of the dimensions of rejection, emotional warmth, and overprotection. Each scale is answered by the subject separately for mother and father. Reliability and validity findings have been reported.6062 To assess family functioning, interviewed parents completed the McMaster Family Assessment Device (FAD63), which is based on the McMaster Model of Family Functioning. The FAD assesses 6 dimensions of family functioning: problem solving, communication, roles, affective responsiveness, affective involvement, and behavior control. The scale "general functioning" assesses the overall health/psychopathology of the family. The subject rates her or his agreement with how adequately the item decribes her or his family. Psychometric properties of the FAD have been reported.64

STATISTICAL ANALYSES

The aim of this study was to assess the association of parental social phobia, other parental psychopathology, parenting style, and family functioning with social phobia in adolescent respondents. Respondents' social phobia status was defined as the cumulative lifetime incidence of social phobia reported at baseline or first follow-up. For all family history analyses, the occurence of a diagnosis in either mother or father was taken as the unit of the analyses. Parental diagnoses were organized so that parents with social phobia could also have other diagnoses, but parents with other psychopathology (other anxiety disorders, depression, alcohol use disorders) could not have social phobia. In the logistic regressions used to calculate odds ratios (ORs65), parental psychopathology, parenting styles, and family functioning were the independent variables, while respondents' social phobia was the dependent variable. To investigate separate associations with generalized and nongeneralized social phobia, multinomial logistic regressions were used.65 The resulting ORs describe the association between the covariate and the respective subtype in the population in which the other subtype does not occur. Mean scores of all family environment scales were divided by their SDs to improve the comparability of associations. Because of the positively skewed shape of the distributions of these scores, differences between parental psychopathology groups were analyzed with gamma regressions65,66 with multiplicative effects. To apply the gamma distribution, scales were transformed so that the minimum score was 0. For 1 of the scales (emotional warmth), scores were negatively skewed; in this case, scores (x) were replaced with (maximum − x), so that gamma regressions could be applied. Calculations were made with the LOGISTIC, SVYMLOG, XTGEE, SVYTAB, and ST procedures of the software package Stata.67 For the examination of age of onset data, survival analyses were performed. The Kaplan-Meier method was used to estimate cumulative lifetime incidences; this method recognizes age-censoring for respondents younger than the maximum age (19 years).68 Differences in terms of hazard rates were tested with the Cox model for discrete time (year intervals of age)66 while testing the proportional hazards assumption (ie, hazard ratios [HR] independent of age).69 This assumption was not violated, and no cohort effects were found.

SOCIAL PHOBIA IN RESPONDENTS AND PARENTS

Of the respondents, 5.6% fullfilled criteria for DSM-IV social phobia; 4.4% met criteria for the nongeneralized subtype; and generalized social phobia was present in 1.1% (Table 2). Social phobia was slightly more frequent in women than in men (6.9% vs 4.2%; independence test: design-based F1,1052 = 3,40; P = .06). One hundred thirty-seven parents (unweighted numbers) fulfilled criteria for either probable or definite social phobia. In 134 cases the mother was affected, and in 3 cases the father was affected. In no case were both parents affected by social phobia. Diagnostic information about social phobia in 2 fathers and 5 mothers was reported solely from the respondent at baseline, whereas all other cases of parental social phobia were obtained directly from the parental interviews.

Table Graphic Jump LocationTable 2. Social Phobia in Respondents and Their Parents (Weighted Data)*
PARENTAL PSYCHOPATHOLOGY AND SOCIAL PHOBIA IN OFFSPRING

Offspring of parents with DSM-IV social phobia had higher rates of social phobia than offspring of parents without psychopathology (9.6% vs 2.1%) (Table 3). Rates of social phobia were also elevated in adolescents whose parents met criteria for other anxiety, depressive, or alcohol use disorders. Logistic regression analyses revealed the highest sample OR when parents were affected by social phobia. There was no notable difference in whether parental social phobia was diagnosed at the probable (OR, 5.2; 95% CI, 1.5-17.3; P = .008) or the definite (OR, 4.0, 95% CI, 1.0-14.8; P = .04) level. Slightly lower associations were found for the other mental disorders in parents. Respondents whose parents suffer from social phobia and multiple comorbid other disorders seem to have a greater risk to meet criteria for DSM-IV social phobia. No significant interactions between any form of parental psychopathology and sex of the respondent were found.

Table Graphic Jump LocationTable 3. Association Between Parental Psychopathology and DSM-IV Social Phobia in Adolescents*

The same pattern of results emerged when all the associations were adjusted for the effects of respondents' comorbidity. Controlling for the presence of other anxiety, depressive, and alcohol use disorders did not substantially alter the significance and strengths of the associations shown in Table 3. Subsetting the analyses to only directly interviewed parents yielded qualitatively the same associations, but all but one failed to reach significance.

ASSOCIATIONS WITH SUBTYPES

When nongeneralized social phobia in respondents was considered separately as the outcome, associations were found for parental social phobia (OR, 3.3; 95% CI, 1.0-10.3; P = .04), for other parental anxiety disorders (OR, 2.9; 95% CI, 1.1-7.4; P = .02), and parental depression (OR, 3.0; 95% CI, 1.1-7.7; P = .02). Because of the fact that there were no cases of generalized social phobia in offspring without parental psychopathology, no separate ORs could be calculated for the generalized subtype. However, it is remarkable that 4 of the 13 adolescents with social phobia with parental social phobia met criteria for the generalized subtype. Lower percentages of generalized social phobia were found among respondents whose parents are affected by other mental disorders.

PARENTAL PSYCHOPATHOLOGY AND AGE OF ONSET

For respondents with parental social phobia, the survival curve decreases most steeply, while the curve for respondents without parental psychopathology decreases only slightly (Figure 1). Statistical analyses showed that these 2 curves were significantly different (HR, 4.4; 95% CI, 1.5-12.2; P = .004), indicating a higher incidence rate of social phobia in nearly every year in respondents whose parents are affected by social phobia. A comparison of the cumulative incidence age-of-onset curves of nongeneralized and generalized social phobics with parental social phobia revealed an earlier onset of the generalized subtype (6 vs 11 years) in adolescents affected by parental social phobia.

Place holder to copy figure label and caption

Onset of social phobia among respondents with parents with social phobia (n = 134), parents with psychopathology, excluding social phobia (n = 654), and those whose parents had no psychopathology (n = 259). Nw indicates weighted N.

Graphic Jump Location
PARENTING STYLE AND FAMILY FUNCTIONING

Higher parental overprotection and higher parental rejection were significantly associated with increased rates of social phobia in offspring. Concerning emotional warmth, the negative association just failed to reach significance. The analyses of the FAD family functioning scales revealed no associations between any specific scale and offsprings' social phobia. Therefore, only the overall general functioning scale score is reported (Table 4).

Table Graphic Jump LocationTable 4. Associations of Parenting Styles and Family Functioning (Metric Covariates) and DSM-IV Social Phobia in Respondents*

With regard to associations between parenting style and parental mental disorders, parental alcohol use disorder was found to be slightly associated with emotional warmth (mean ratio [MR], 1.1; 95% CI, 1.0-1.2; P = .048), and parental anxiety disorder other than social phobia was found to be positively associated with parental rejection (MR, 1.3; 95% CI, 1.0-1.6; P = .02).

The examination of the interactions between parenting behavior and parental psychopathology with regard to respondents' social phobia status revealed that the association between parental rejection and adolescents' social phobia is significantly greater when parents are affected by psychopathology, irrespective of the specific parental disorders (association difference in comparison with no mental disorder: for social phobia [OR, 2.3; 95% CI, 1.1-4.6; P = .02]; any other anxiety disorder [OR, 1.8; 95% CI, 0.9-3.5; P = .09]; any depressive disorder [OR, 2.1; 95% CI, 1.0-4.1; P = .03]; any alcohol use disorder [OR, 2.1; 95% CI, 1.0-4.3; P = .04]; comorbid social phobia [OR, 2.4; 95% CI, 1.1-4.8; P = .02]). The findings for parental overprotection were similar, but failed to reach significance.

An examination of the conditional effects of parental psychopathology and parenting styles on adolescents' social phobia (Table 5) revealed that when controlling for parenting style, all assocations between parental psychopathology and offsprings' social phobia remained significant. Likewise, controlling for parental psychopathology resulted in only slightly lower, but still significant, associations between parental overprotection and parental rejection and respondents' social phobia.

Table Graphic Jump LocationTable 5. Conditional Associations Between Parental Psychopathology, Parenting Style, and Social Phobia in Offspring*

The key finding that children of social phobic parents are more likely to develop social phobia than children of healthy parents suggests that parental social phobia is a risk factor for social phobia in offspring. This finding is in line with the results of prior family studies in patient samples,3035 but it extends those findings to a community sample. Providing the first study in an epidemiological sample, unaffected by potential clinical selection and help-seeking bias likely to occur in patient samples, we demonstrated that offspring of parents with social phobia are significantly more likely to have DSM-IV social phobia than offspring of healthy parents, and the parent-offspring association can be found even in adolescents who have not yet completed the full risk period for onset of the disorder. Data further suggest that the parent-offspring association may be stronger for the generalized subtype34,35; however, these findings require confirmation because of the small number of youth with the generalized subtype.

Genetic and/or environmental factors might be responsible for the parent-offspring association since twin and adoption studies are needed to discriminate heritable sources of variance. A twin study of social phobia by Kendler et al17,19 reveals that both genetic and nongenetic factors influence the liability to social phobia. Environmental models of the development of social phobia in offspring could include modeling or restricted opportunities to learn social skills.23,24

In accordance with reports from the National Comorbidity Survey,10 increased rates of DSM-IV social phobia were also found in respondents whose parents suffer from other anxiety disorders, depression, or alcohol use disorders; these associations remained stable when controlled for adolescents' comorbidity. Although this finding confirms the results of previous family studies that demonstrate common familial influences for social phobia and depression (M.B.S., M.F., N. Mueller, MD, M.H., H.-U.W., unpublished data, 2000),5,18 the finding that parental alcoholism and other anxiety disorders increase the risk for social phobia in offspring seem to differ somewhat from the findings of 3 patient-based family studies30,32,33 and the Yale Family Study of Comorbidity of Substance Use and Anxiety, where half of the sample of anxiety probands was community-based.20 These studies argue for a lack of a familial link between social phobia and these disorders. We can only speculate that the contradictory findings may be attribuable to different design features.

Similar to previous studies,36 none of the family characteristics assessed with the FAD was associated with respondents' social phobia. However, there were associations with parenting style as perceived by the respondent regarding parental overprotection and rejection. This result is in accordance with the findings in clinical samples,3942 but provides stronger evidence because information about parenting style was obtained directly from adolescents still living at home (94%), suggesting that the associations are not merely the result of recall bias. All associations between parenting styles and adolescents' social phobia remained stable when controlled for parental psychopathology, suggesting that parental rejection and overprotection may be additional family-environment risk factors for social phobia independent of parental psychopathology. Previous studies39,40 suggest potential explanations for how parental characteristics may contribute to social phobia: overprotection may restrict the offsprings' development of autonomy and social competence; the combination of rejection and overprotection may lead to a dysfunctional parent-child bond, which may result in difficulties and anxieties in social situations; in addition, overprotection may keep the offspring from engaging in social situations, thereby restricting the opportunities to learn social skills.23,24

The data suggest that multiple familial factors are involved in the development of social phobia. Our findings indicate that not only parental social phobia, but also other parental psychopathology, particularly parental depression and parenting style (individually and in combination), may contribute to the development of social phobia.

Limitations of the study include the lack of direct interviews with fathers regarding social phobia and depression; this was likely to yield underestimates of paternal psychopathology.5759 In addition, because youth have not passed through the entire risk period for onset of social phobia, the findings are still not conclusive; future analyses that include cases of later-onset findings will most likely lead to even stronger parent-offspring associations.

Accepted for publication April 11, 2000.

Supported by project 01EB94056 from the German Ministry of Research and Technology, Bonn (Dr Wittchen). The preparation of this article was supported by an unrestricted educational grant from SmithKline Beecham, Philadelphia, Pa.

We thank Robin Carter, BA, for her helpful comments and suggestions.

Corresponding author: Roselind Lieb, PhD, Max Planck Institute of Psychiatry, Clinical Psychology and Epidemiology Unit, Kraepelinstrasse 2, Munich 80804, Germany (e-mail: lieb@mpipsykl.mpg.de).

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Parker  G Reported parental characteristics of agorahobics and social phobics. Br J Psychiatry. 1979;135555- 560
Link to Article
Arrindell  WAKwee  MGMethorst  GJvan der Ende  JPol  EMoritz  BJ Perceived parental rearing styles of agoraphobic and socially phobic in-patients. Br J Psychiatry. 1989;155526- 535
Link to Article
Gerlsma  CEmmelkamp  PMArrindell  WA Anxiety, depression, and perception of early parenting: a meta-analysis. Clin Psychol Rev. 1990;10251- 277
Link to Article
Bruch  MAHeimberg  RGBerger  PCollins  TM Social phobia and perceptions of early parental and personal characteristics. Anxiety Res. 1989;257- 65
Link to Article
Rapee  RMMelville  LF Recall of family factors in social phobia and panic disorder: comparison of mother and offspring reports. Depress Anxiety. 1997;57- 11
Link to Article
Rapee  RM The potential role of childrearing practices in the development of anxiety and depression. Clin Psychol Rev. 1997;1747- 67
Link to Article
Wittchen  HUNelson  GBLachner  G Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychol Med. 1998;28109- 126
Link to Article
Wittchen  HUPerkonigg  ALachner  GNelson  CB Early Developmental Stages of Psychopathology Study (EDSP): objectives and design. Eur Addict Res. 1998;418- 27
Link to Article
Höfler  MLieb  RPerkonigg  ASchuster  PSonntag  HWittchen  HU Covariates of cannabis use progression in a representative population sample of adolescents: a prospective examination of vulnerability and risk factors. Addiction. 1999;941679- 1694
Link to Article
Perkonigg  ALieb  RHöfler  MSchuster  PSonntag  HWittchen  HU Patterns of cannabis use, abuse and dependence over time: incidence, progression and stability in a sample of 1228 adolescents. Addiction. 1999;941663- 1678
Link to Article
Wittchen  HUPfister  H DIA-X-Interviews: Manual für Screening-Verfahren und Interview; Interviewheft Längsschnittuntersuchung (DIA-X-Lifetime); Ergänzungsheft (DIA-X-Lifetime); Interviewheft Querschnittuntersuchung (DIA-X-12 Monate); Ergänzungsheft (DIA-X-12Monate); PC-Programm zur Durchführung des Interviews (Längs-und Querschnittuntersuchung); Auswertungsprogramm.  Frankfurt, Germany Swets & Zeitlinger1997;
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Washington, DC American Psychiatric Association1994;
World Health Organization, International Classification of Diseases, 10th Revision (ICD-10).  Geneva, Switzerland World Health Organization1992;
Lachner  GWittchen  HUPerkonigg  AHolly  ASchuster  PWunderlich  UTürk  DGarczynski  EPfister  H Structure, content and reliability of the Munich-Composite International Diagnostic Interview (M-CIDI) substance use sections. Eur Addict Res. March1998;428- 41
Link to Article
Reed  VGander  FPfister  HSteiger  ASonntag  HTrenkwalder  CHundt  WWittchen  HU To what degree the Composite International Diagnostic Interview (CIDI) correctly identifies DSM-IV disorders? testing validity issues in a clinical sample. Int J Methods Psychiatr Res. 1998;7142- 155
Link to Article
Wittchen  HULachner  GWunderlich  UPfister  H Test-retest reliability of the computerized DSM-IV version of the Munich-Composite International Diagnostic Interview (M-CIDI). Soc Psychiatry Psychiatr Epidemiol. 1998;33568- 578
Link to Article
Lachner  GWittchen  HU Münchener Composite International Diagnostic Interview: Familiengenetische Version (M-CIDI-FG).  Munich, Germany Max Planck Institut für Psychiatrie Eigendruck1997;
Andreasen  NCEndicott  JSpitzer  RLWinokur  G The family history method using diagnostic criteria: reliability and validity. Arch Gen Psychiatry. 1977;341229- 1235
Link to Article
Andreasen  NCRice  JEndicott  JReich  TCoryell  W The family history approach to diagnosis: how useful is it? Arch Gen Psychiatry. 1986;43421- 429
Link to Article
Thompson  WDOrvaschel  HPrusoff  BA.Kidd  KK An evaluation of the family history method for ascertaining psychiatric disorders. Arch Gen Psychiatry. 1982;3953- 58
Link to Article
Orvaschel  HThompson  WDBelanger  APrusoff  BAKidd  KK Comparison of the family history method to direct interview: factors affecting the diagnosis of depression. J Affect Disord. 1982;449- 59
Link to Article
Schumacher  JEisemann  MBrähler  E Rückblick auf die Eltern: Der Fragebogen zum erinnerten elterlichen Erziehungsverhalten (FEE). Diagnostica. 1999;45194- 204
Link to Article
Perris  CJacobsson  LLindström  Hvon Knorring  LPerris  H Development of a new inventory for assessing memories of parental rearing behaviour. Acta Psychiatr Scand. 1980;61265- 274
Link to Article
Arrindell  WAPerris  CEisemann  Mvan der Ende  JGaszner  PIwawaki  SMaj  MZhang  JE Parental rearing behaviour from a cross-cultural perspective: a summary of data obtained in 14 nations. Perris  CArrindell  WAEisemann  Meds.Parenting and Psychopathology New York, NY John Wiley & Sons1994;145- 171
Epstein  NBBaldwin  LMBishop  DS The McMaster Family Assessment Device. J Marital Fam Ther. 1983;9171- 180
Link to Article
Kabacoff  RIMiller  IWBishop  DSEpstein  NBKeitner  GI A psychometric study of the McMaster Family Assessment Device in psychiatric, medical, and nonclinical samples. J Fam Psychol. 1990;3431- 439
Link to Article
McCullagh  PNelder  F Generalized Linear Models.  London, England Chapman & Hall1989;
Fahrmeier  LTutz  G Multivariate Statistical Modelling Based on Generalized Linear Models.  New York, NY Springer-Verlag NY Inc1994;
StataCorp, Stata Statistical Software: Release 6.0.  College Station, Tex Stata Corp1999;
Andersen  PKKeiding  N Survival analysis. Armitage  PDavid  HHeds.Advances in Biometry 50 Years of the International Biometric Society New York, NY John Wiley & Sons Inc1996;177- 199
Grambsch  PMTherneau  TM Proportional hazards tests and diagnostics based on weighted residuals. Biometrika. 1994;81515- 526
Link to Article

Figures

Place holder to copy figure label and caption

Onset of social phobia among respondents with parents with social phobia (n = 134), parents with psychopathology, excluding social phobia (n = 654), and those whose parents had no psychopathology (n = 259). Nw indicates weighted N.

Graphic Jump Location

Tables

Table Graphic Jump LocationTable 1. Response Rates and Demographic Distribution of Adolescents Aged 14 to 17 Years at Baseline*
Table Graphic Jump LocationTable 2. Social Phobia in Respondents and Their Parents (Weighted Data)*
Table Graphic Jump LocationTable 3. Association Between Parental Psychopathology and DSM-IV Social Phobia in Adolescents*
Table Graphic Jump LocationTable 4. Associations of Parenting Styles and Family Functioning (Metric Covariates) and DSM-IV Social Phobia in Respondents*
Table Graphic Jump LocationTable 5. Conditional Associations Between Parental Psychopathology, Parenting Style, and Social Phobia in Offspring*

References

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Parker  G Parental "affectionless control" as an antecedent to adult depression: a risk factor delineated. Arch Gen Psychiatry. 1983;40956- 960
Link to Article
Parker  G Reported parental characteristics of agorahobics and social phobics. Br J Psychiatry. 1979;135555- 560
Link to Article
Arrindell  WAKwee  MGMethorst  GJvan der Ende  JPol  EMoritz  BJ Perceived parental rearing styles of agoraphobic and socially phobic in-patients. Br J Psychiatry. 1989;155526- 535
Link to Article
Gerlsma  CEmmelkamp  PMArrindell  WA Anxiety, depression, and perception of early parenting: a meta-analysis. Clin Psychol Rev. 1990;10251- 277
Link to Article
Bruch  MAHeimberg  RGBerger  PCollins  TM Social phobia and perceptions of early parental and personal characteristics. Anxiety Res. 1989;257- 65
Link to Article
Rapee  RMMelville  LF Recall of family factors in social phobia and panic disorder: comparison of mother and offspring reports. Depress Anxiety. 1997;57- 11
Link to Article
Rapee  RM The potential role of childrearing practices in the development of anxiety and depression. Clin Psychol Rev. 1997;1747- 67
Link to Article
Wittchen  HUNelson  GBLachner  G Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychol Med. 1998;28109- 126
Link to Article
Wittchen  HUPerkonigg  ALachner  GNelson  CB Early Developmental Stages of Psychopathology Study (EDSP): objectives and design. Eur Addict Res. 1998;418- 27
Link to Article
Höfler  MLieb  RPerkonigg  ASchuster  PSonntag  HWittchen  HU Covariates of cannabis use progression in a representative population sample of adolescents: a prospective examination of vulnerability and risk factors. Addiction. 1999;941679- 1694
Link to Article
Perkonigg  ALieb  RHöfler  MSchuster  PSonntag  HWittchen  HU Patterns of cannabis use, abuse and dependence over time: incidence, progression and stability in a sample of 1228 adolescents. Addiction. 1999;941663- 1678
Link to Article
Wittchen  HUPfister  H DIA-X-Interviews: Manual für Screening-Verfahren und Interview; Interviewheft Längsschnittuntersuchung (DIA-X-Lifetime); Ergänzungsheft (DIA-X-Lifetime); Interviewheft Querschnittuntersuchung (DIA-X-12 Monate); Ergänzungsheft (DIA-X-12Monate); PC-Programm zur Durchführung des Interviews (Längs-und Querschnittuntersuchung); Auswertungsprogramm.  Frankfurt, Germany Swets & Zeitlinger1997;
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Washington, DC American Psychiatric Association1994;
World Health Organization, International Classification of Diseases, 10th Revision (ICD-10).  Geneva, Switzerland World Health Organization1992;
Lachner  GWittchen  HUPerkonigg  AHolly  ASchuster  PWunderlich  UTürk  DGarczynski  EPfister  H Structure, content and reliability of the Munich-Composite International Diagnostic Interview (M-CIDI) substance use sections. Eur Addict Res. March1998;428- 41
Link to Article
Reed  VGander  FPfister  HSteiger  ASonntag  HTrenkwalder  CHundt  WWittchen  HU To what degree the Composite International Diagnostic Interview (CIDI) correctly identifies DSM-IV disorders? testing validity issues in a clinical sample. Int J Methods Psychiatr Res. 1998;7142- 155
Link to Article
Wittchen  HULachner  GWunderlich  UPfister  H Test-retest reliability of the computerized DSM-IV version of the Munich-Composite International Diagnostic Interview (M-CIDI). Soc Psychiatry Psychiatr Epidemiol. 1998;33568- 578
Link to Article
Lachner  GWittchen  HU Münchener Composite International Diagnostic Interview: Familiengenetische Version (M-CIDI-FG).  Munich, Germany Max Planck Institut für Psychiatrie Eigendruck1997;
Andreasen  NCEndicott  JSpitzer  RLWinokur  G The family history method using diagnostic criteria: reliability and validity. Arch Gen Psychiatry. 1977;341229- 1235
Link to Article
Andreasen  NCRice  JEndicott  JReich  TCoryell  W The family history approach to diagnosis: how useful is it? Arch Gen Psychiatry. 1986;43421- 429
Link to Article
Thompson  WDOrvaschel  HPrusoff  BA.Kidd  KK An evaluation of the family history method for ascertaining psychiatric disorders. Arch Gen Psychiatry. 1982;3953- 58
Link to Article
Orvaschel  HThompson  WDBelanger  APrusoff  BAKidd  KK Comparison of the family history method to direct interview: factors affecting the diagnosis of depression. J Affect Disord. 1982;449- 59
Link to Article
Schumacher  JEisemann  MBrähler  E Rückblick auf die Eltern: Der Fragebogen zum erinnerten elterlichen Erziehungsverhalten (FEE). Diagnostica. 1999;45194- 204
Link to Article
Perris  CJacobsson  LLindström  Hvon Knorring  LPerris  H Development of a new inventory for assessing memories of parental rearing behaviour. Acta Psychiatr Scand. 1980;61265- 274
Link to Article
Arrindell  WAPerris  CEisemann  Mvan der Ende  JGaszner  PIwawaki  SMaj  MZhang  JE Parental rearing behaviour from a cross-cultural perspective: a summary of data obtained in 14 nations. Perris  CArrindell  WAEisemann  Meds.Parenting and Psychopathology New York, NY John Wiley & Sons1994;145- 171
Epstein  NBBaldwin  LMBishop  DS The McMaster Family Assessment Device. J Marital Fam Ther. 1983;9171- 180
Link to Article
Kabacoff  RIMiller  IWBishop  DSEpstein  NBKeitner  GI A psychometric study of the McMaster Family Assessment Device in psychiatric, medical, and nonclinical samples. J Fam Psychol. 1990;3431- 439
Link to Article
McCullagh  PNelder  F Generalized Linear Models.  London, England Chapman & Hall1989;
Fahrmeier  LTutz  G Multivariate Statistical Modelling Based on Generalized Linear Models.  New York, NY Springer-Verlag NY Inc1994;
StataCorp, Stata Statistical Software: Release 6.0.  College Station, Tex Stata Corp1999;
Andersen  PKKeiding  N Survival analysis. Armitage  PDavid  HHeds.Advances in Biometry 50 Years of the International Biometric Society New York, NY John Wiley & Sons Inc1996;177- 199
Grambsch  PMTherneau  TM Proportional hazards tests and diagnostics based on weighted residuals. Biometrika. 1994;81515- 526
Link to Article

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