Adverse parenting as a risk factor in the occurrence of anxiety disorders

A study in six European countries
  • Dirk Heider
  • Herbert Matschinger
  • Sebastian Bernert
  • Jordi Alonso
  • Traolach S. Brugha
  • Ronny Bruffaerts
  • Giovanni de Girolamo
  • Sandra Dietrich
  • Matthias C. Angermeyer
  • The ESEMeD/MHEDEA 2000 investigators



The aim of the study was to test the homogeneity of the association between adverse parenting and anxiety disorders within these disorders as well as among six European countries.


Based on data from 8,232 respondents (part II sample) originating from the European study of the epidemiology of mental disorders (ESEMeD), we examined the association between three dimensions of parental rearing (care, overprotection, authoritarianism) measured by a short form of the parental bonding instrument (PBI) and anxiety disorders by computing one logistic regression model per disorder.


A similar pattern of recalled parenting behaviour across the four anxiety disorders assessed was found, with care and overprotection having the strongest associations. There were only minor country-specific variations of this pattern.


Our results suggest an association between adverse parenting and the risk of anxiety disorders in particular as well as psychiatric disorders in general that is rather non-disorder specific.

Key words

anxiety disorders parental bonding instrument epidemiological study 


  1. 1.
    Alonso J, Ferrer M, Romera B et al (2002) The European study of the epidemiology of mental disorders (ESEMeD/MHEDEA 2000) project: rationale and methods. Int J Methods Psychiatr Res 11:55–67PubMedCrossRefGoogle Scholar
  2. 2.
    Alperstein G, Raman S (2003) Promoting mental health and emotional well-being among children and youth: a role for community child health? Child Care Health Dev 29:269–274PubMedCrossRefGoogle Scholar
  3. 3.
    Bowlby J (1973) Attachment and loss. Separation, anxiety and anger, vol II. The Hogarth Press, LondonGoogle Scholar
  4. 4.
    Bowlby J (1977) Making and breaking of affectional bonds .1. Etiology and psychopathology in light of attachment theory. Br J Psychiatry 130:201–210PubMedCrossRefGoogle Scholar
  5. 5.
    Carter MM, Sbrocco T, Lewis EL, Friedman EK (2001) Parental bonding and anxiety: differences between African American and European American college students. J Anxiety Disord 15:555–569PubMedCrossRefGoogle Scholar
  6. 6.
    Clogg CC, Petkova E, Haritou A (1995) Statistical methods for comparing regression coefficients between models. Am J Sociol 100:1271–1293Google Scholar
  7. 7.
    Cox BJ, Enns MW, Clara IP (2000) The parental bonding instrument: confirmatory evidence for a three-factor model in a psychiatric clinical sample and in the National comorbidity survey. Soc Psychiatry Psychiatr Epidemiol 35:353–357PubMedCrossRefGoogle Scholar
  8. 8.
    ESEMED/MHEDEA 2000 Investigators (2004) Sampling and methods of the European study of epidemiology of mental disorders (ESEMeD) project. Acta Psychiatr Scand 109(Suppl 420):1–13Google Scholar
  9. 9.
    Enns MW, Cox BJ, Clara I (2002) Parental bonding and adult psychopathology: results from the US National Comorbidity Survey. Psychol Med 32:997–1008PubMedCrossRefGoogle Scholar
  10. 10.
    Faravelli C, Panichi C, Pallanti S, Paterniti S, Grecu LM, Rivelli S (1991) Perception of early parenting in panic and agoraphobia. Acta Psychiatr Scand 84:6–8PubMedCrossRefGoogle Scholar
  11. 11.
    Feldner MT, Zvolensky MJ, Leen-Feldner EW (2004) A critical review of the empirical literature on coping and panic disorder. Clin Psychol Rev 24:123–148PubMedCrossRefGoogle Scholar
  12. 12.
    General assembly of the united nations (1989) The Convention on the rights of the child. 1989. Adopted by the General Assembly of the United Nations on 20 NovemberGoogle Scholar
  13. 13.
    Heider D, Matschinger H, Bernert S, Vilagut G, Martinez-Alonso M, Dietrich S, et al (2005) Empirical evidence for an invariant three-factor structure of the parental bonding instrument in six European countries. Psychiatry Res 135:237–247PubMedCrossRefGoogle Scholar
  14. 14.
    Hettema JM, Neale MC, Kendler KS (2001) A review and meta-analysis of the genetic epidemiology of anxiety disorders. Am J Psychiatry 158:1568–1578PubMedCrossRefGoogle Scholar
  15. 15.
    Hur YM, Bouchard TJ (1995) Genetic influences on perceptions of childhood family environment—a reared apart twin study. Child Dev 66:330–345PubMedCrossRefGoogle Scholar
  16. 16.
    Kendler KS, Myers J, Prescott CA (2000) Parenting and adult mood, anxiety and substance use disorders in female twins: an epidemiological, multi-informant, retrospective study. Psychol Med 30:281–294PubMedCrossRefGoogle Scholar
  17. 17.
    Kendler KS, Sham PC, Maclean CJ (1997) The determinants of parenting: an epidemiological, multi-informant, retrospective study. Psychol Med 27:549–563PubMedCrossRefGoogle Scholar
  18. 18.
    Kessler RC, Ustun TB (2004) The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 13:93–121PubMedCrossRefGoogle Scholar
  19. 19.
    Leon CA, Leon A (1990) Panic disorder and parental bonding. Psychiatr Ann 120:503–508Google Scholar
  20. 20.
    Mackinnon A, Henderson AS, Andrews G (1993) Parental affectionless control as an antecedent to adult depression—a risk factor refined. Psychol Med 23:135–141PubMedGoogle Scholar
  21. 21.
    Mackinnon AJ, Henderson AS, Scott R, Duncan-Jones P (1989) The Parental Bonding Instrument (PBI): an epidemiological study in a general population sample. Psychol Med 19:1023–1034PubMedGoogle Scholar
  22. 22.
    Manassis K, Owens M, Adam KS, West M, Sheldon-Keller AE (1999) Assessing attachment: convergent validity of the adult attachment interview and the parental bonding instrument. Aust NZ J Psychiatr 33:559–567CrossRefGoogle Scholar
  23. 23.
    Manicavasagar V, Silove D, Wagner R, Hadzi-Pavlovic D (1999) Parental representations associated with adult separation anxiety and panic disorder-agoraphobia. Aust NZ J Psychiatr 33:422–428CrossRefGoogle Scholar
  24. 24.
    Narita T, Sato T, Hirano S, Gota M, Sakado K, Uehara T (2000) Parental child-rearing behavior as measured by the parental bonding instrument in a Japanese population: factor structure and relationship to a lifetime history of depression. J Affect Disord 57:229–234PubMedCrossRefGoogle Scholar
  25. 25.
    Pacchierotti C, Bossini L, Castrogiovanni A, Pieraccini F, Soreca I, Castrogiovanni P (2002) Attachment and panic disorder. Psychopathology 35:347–354PubMedCrossRefGoogle Scholar
  26. 26.
    Parker G (1979) Reported parental characteristics of agoraphobics and social phobics. Br J Psychiatry 135:555–560PubMedGoogle Scholar
  27. 27.
    Parker G (1979) Parental characteristics in relation to depressive disorders. Br J Psychiatry 134:138–147PubMedGoogle Scholar
  28. 28.
    Parker G (1981) Parental reports of depressives. An investigation of several explanations. J Affect Disord 3:131–140PubMedCrossRefGoogle Scholar
  29. 29.
    Parker G (1983) Parental ‘affectionless control’ as an antecedent to adult depression. A risk factor delineated. Arch Gen Psychiatry 40:956–960PubMedGoogle Scholar
  30. 30.
    Parker G (1989) The parental bonding instrument: psychometric properties reviewed. Psychiatr Dev 7:317–335PubMedGoogle Scholar
  31. 31.
    Parker G (1990) The parental bonding instrument. A decade of research. Soc Psychiatry Psychiatr Epidemiol 25:281–282PubMedCrossRefGoogle Scholar
  32. 32.
    Parker G, Tupling H, Brown LB (1979) Parental bonding instrument. Br J Med Psychol 52:1–10Google Scholar
  33. 33.
    Patton GC, Coffey C, Posterino M, Carlin JB, Wolfe R (2001) Parental ‘affectionless control’ in adolescent depressive disorder. Soc Psychiatry Psychiatr Epidemiol 36:475–480PubMedCrossRefGoogle Scholar
  34. 34.
    Perris C, Arrindell WA, Eiseman M. (1994) Linking the experience of dysfunctional parental rearing with manifest psychopathology: a theoretical framework. Parenting and psychopathology. Wiley, New York, pp 3–32Google Scholar
  35. 35.
    Plantes MM, Prusoff BA, Brennan J, Parker G (1988) Parental representations of depressed outpatients from a U.S.A. sample. J Affect Disord 15:149–155PubMedCrossRefGoogle Scholar
  36. 36.
    Sato T, Narita T, Hirano S, Kusunoki K, Sakado K, Uehara T (1999) Confirmatory factor analysis of the parental bonding instrument in a Japanese population. Psychol Med 29:127–133PubMedCrossRefGoogle Scholar
  37. 37.
    Sato T, Sakado K, Uehara T, Narita T, Hirano S, Nishioka K et al (1998) Dysfunctional parenting as a risk factor to lifetime depression in a sample of employed Japanese adults: evidence for the ‘affectionless control’ hypothesis. Psychol Med 28:737–742PubMedCrossRefGoogle Scholar
  38. 38.
    Sato T, Uehara T, Sakado K, Nishioka K, Ozaki N, Nakamura M et al (1997) Dysfunctional parenting and a lifetime history of depression in a volunteer sample of Japanese workers. Acta Psychiatr Scand 96:306–310PubMedCrossRefGoogle Scholar
  39. 39.
    Silove D, Parker G, Hadzi-Pavlovic D, Manicavasagar V, Blaszczynski A (1991) Parental representations of patients with panic disorder and generalised anxiety disorder. Br J Psychiatry 159:835–841PubMedGoogle Scholar
  40. 40.
    Statacorp (2003) Stata Statistical Software: Release 8.0. Stata Corporation, College StationGoogle Scholar
  41. 41.
    Turgeon L, O’Connor KP, Marchand A, Freeston MH (2002) Recollections of parent-child relationships in patients with obsessive-compulsive disorder and panic disorder with agoraphobia. Acta Psychiatr Scand 105:310–316PubMedCrossRefGoogle Scholar
  42. 42.
    Weesie J (1999) Seemingly unrelated estimation and the cluster adjusted sandwich estimator. Stata Technical Bulletin 52:34–47Google Scholar
  43. 43.
    Wiborg IM, Dahl AA (1997) The recollection of parental rearing styles in patients with panic disorder. Acta Psychiatr Scand 96:58–63PubMedCrossRefGoogle Scholar
  44. 44.
    Wilhelm K, Niven H, Parker G, Hadzi-Pavlovic D (2005) The stability of the parental bonding instrument over a 20-year period. Psychol Med 35:387–393PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Dirk Heider
    • 1
  • Herbert Matschinger
    • 2
  • Sebastian Bernert
    • 2
  • Jordi Alonso
    • 3
  • Traolach S. Brugha
    • 4
  • Ronny Bruffaerts
    • 5
  • Giovanni de Girolamo
    • 6
  • Sandra Dietrich
    • 2
  • Matthias C. Angermeyer
    • 2
  • The ESEMeD/MHEDEA 2000 investigators
  1. 1.Health Economics Research Unit, Dept. of PsychiatryUniversity of LeipzigLeipzigGermany
  2. 2.Dept. of PsychiatryUniversity of LeipzigLeipzigGermany
  3. 3.Health Services Research UnitInstitut Municipal d’Investigació MèdicaBarcelonaSpain
  4. 4.Dept. of PsychiatryUniversity of LeicestermLeicesterUK
  5. 5.Dept. of PsychiatryUniversity Hospital GasthuisbergLeuvenBelgium
  6. 6.Dept. of Mental HealthAUSL Città di BolognaBolognaItaly

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