|Year : 2013 | Volume
| Issue : 2 | Page : 131-137
Anxiety in school students: Role of parenting and gender
Ajay Kumar Bakhla1, Prakriti Sinha2, Rajiv Sharan3, Yashi Binay4, Vijay Verma5, Suprakash Chaudhury6
1 Department of Psychiatry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
2 Clinical Psychologist, Tata Motors Hospital, Jamshedpur, Jharkhand, India
3 Consultant Pediatrician, Tata Motors Hospital, Jamshedpur, Jharkhand, India
4 Senior Resident Pediatrics, Moolchand Hospital, New Delhi, India
5 Senior Resident, Psychiatry, Ranchi Institute of Neuro Psychiatry and Applied Sciences, Ranchi, Jharkhand, India
6 Department of Psychiatry, Pravara Institute of Medical Sciences (Deemed University) Rural Medical College and Pravara's Rural Hospital, Loni, Maharashtra, India
|Date of Web Publication||21-May-2014|
Department of Psychiatry, Pravara Institute of Medical Sciences (Deemed University) Rural Medical College and Pravara's Rural Hospital, Loni Kalbhor, Pune District, Loni - 413 736, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: The prevalence of anxiety is high in school going children; however pattern of parenting and gender of the child are important factors for the development of anxiety. Gender role and parenting patterns are important construct that vary across different sociocultural setting hence are important to be studied in Indian context. Materials and Methods: In a cross sectional study all students of both sexes studying in class VIII, were assessed using the Spence anxiety scale (children version). Results: The sample consisted of 146 (55% male and 45% female) with a mean age of 12.71 years. A total of 16 (11%) students scored above cutoff for high anxiety, the mean scores across gender shows that female students scored significantly higher in total and all sub types of anxiety. Most of the students perceived their parents 'Democratic' and other two authoritarian and permissive type of parenting were almost equal. There was significantly higher anxiety among the students who perceived their parents as authoritarian. Conclusions: The prevalence of high anxiety was 11% in class VIII students. High anxiety in students was significantly associated with female gender and authoritarian parenting pattern as perceived by the children.
Keywords: Anxiety, authoritarian parenting, democratic parenting, gender role, permissive parenting
|How to cite this article:|
Bakhla AK, Sinha P, Sharan R, Binay Y, Verma V, Chaudhury S. Anxiety in school students: Role of parenting and gender. Ind Psychiatry J 2013;22:131-7
Anxiety disorders are the most common psychiatric diagnosis in school going children worldwide, with an estimated overall prevalence rate of 8% (ranging 4-25%). ,, An Indian study reported the incidence of childhood psychiatric disorders as 18/1000/year.  However, very few Indian studies have been conducted to which assesses the various types of anxiety among school children.The age around puberty is considered as sensitive period of development which is vulnerable to anxiety.  Hence the gender difference at the time of puberty may have a relation to the severity and types of anxiety and other psychopathology. Anxiety may appear in different forms including separation anxiety, social phobia, generalized anxiety, and panic with agoraphobia, obsessive compulsive and specific phobic disorders causing numerous problems in their life  Untreated anxiety disorders can have both short and long term deleterious consequences in children and adolescents.  Research indicate that adolescents with anxiety disorders have lower academic achievement,  problems with peer and parental relationships, , poor vocational adjustment,  negative self-perception,  poor self esteem,  and an increased likelihood of psychiatric disorders later in life. ,
Childhood anxiety has been associated with genetic and various environmental factors, including gender and pattern of parenting.  Gender effects for anxiety disorders and symptoms have been found in studies of children and adolescents in English-speaking countries. Generally, more girls than boys develop anxiety symptoms and disorders. Adolescent girls report a greater number of worries, more separation anxiety, and higher levels of generalized anxiety. ,, However, an earlier Indian study reported that high anxiety was prevalent in 20.1% of boys and 17.9% of girls and this difference was statistically significant.  There are few construct like 'parental control' ,, and 'parental warmth' versus 'parental rejection' comprising parental indifference, withdrawal, neglect, hostility, aggression, lack of affection, approval, and responsiveness , that are associated with level of children anxiety. These constructs are unique to each child and also discriminated across gender of the child. The differing level of 'parental control' constitutes different parenting style i.e. Authoritarian, Democratic and Permissive. Authoritarian parents tend to control child autonomy, restrictive and harsh but these attributes needs to be established from child's perspective. How these parenting types individually impact upon children anxiety is not clear as various studies reported differing findings across socio-cultural settings. ,, Parental attributes may vary as per the gender of the child depending on the socio-cultural and educational background. Child and parent relationships from the perspective of child are important, and this aspect has been less studied, especially in the context of childhood anxiety. In view of the paucity of Indian work in this area of anxiety in school children across gender and lack of information about parenting style from the perspective of child and their impact on various types of anxiety, we planned this cross sectional observational study to assess the anxiety, across gender among class VIII students and to assess if parenting styles as perceived by children are associated with anxiety. The primary goal of the present study was to identify the prevalence of anxiety and its subtypes in school going children, then to look for any gender difference and strength of differences between parenting and childhood anxiety.
| Materials and methods|| |
This was a cross-sectional school-based study, conducted at Little Flower School at Jamshedpur, Jharkhand, India during May 2012. The study protocol was approved by the institutional review board of Tata Motors Hospital Jamshedpur, Jharkhand. A prior appointment was made with school authorities to apprise them of the objectives of the study and to obtain their permission for data collection. Data were collected with the voluntary consent of the adolescent and their parents. Voluntary consent was obtained after sharing the objectives of the study and reassuring the participants about their anonymity (by not recording their names) and the confidentiality of information they were providing.
All students of both sexes studying in all three sections of class VIII, who gave consent, were included for the study. Those with any concurrent medical illness and other disabilities were excluded. Tools used were Socio-demographic data sheet and Spence anxiety scale (children version).
Socio-demographic data sheet
0The socio demographic data sheet included age, gender, number of siblings, parenting style, hobbies and health concerns. To maintain the confidentiality of individual student the name and roll number of the students were not recorded.
Spence anxiety scale
The scale was developed by Susan H. Spence and standardized initially with a large community sample. , Several studies using confirmatory exploratory factor analysis have supported the validity of the six anxiety factors contained within the scale, with children aged 8 through to 17 years. ,, The six factors closely resembled those outlined in DSM-IV namely generalized anxiety, obsessive-compulsive disorder, separation anxiety, social phobia, and panic-agoraphobia, plus the physical injury fears. The measure provides anindication of symptoms related to specific forms of anxiety disorder among children.  The internal consistency of the total score and sub-scales was high, and 12-week test-retest reliability was satisfactory. The Spence anxiety scale correlated strongly with a frequently used child self-report measure of anxiety and significantly, albeit at a lower level, with a measure of depression. 
It was a cross sectional observational study. All subjects were assessed for inclusion - exclusion criteria, and on qualification they were requested to fill up Socio-demographic data sheet and Questionnaire to read and reply on paper by choosing the options provided with each questions.
The collected data of all students was statistically analyzed, using Statistical Package for Social Sciences (SPSS, Inc., Chicago, Illinois) version 10.0.
Data analysis included means, standard deviations and median scores for each gender. The non-parametric Mann-Whitney U test was used to determine if differences existed between the male and female gender for all domains and total score. Statistically significant levels are reported for P values less than or equal to 0.05. Highly significant levels are P values less than 0.001.
| Results|| |
A total of 146 students (55% male and 45% female) were included for the study, [Table 1] summarizes the sample characteristics. The mean age of the group was 12.71 years (13.09 ± 0.58 for male and 12.83 ± 0.57 for females). The high anxiety was found in 11% (n = 16) as per the cut off scores of 42 on total of Spence anxiety scale. [Table 2] gives the gender distribution of parenting styles, sibling seniority and scoring cut off levels above and below across all subscales of Spence anxiety scale including separation anxiety, OCD, Social phobia, panic-Agoraphobia, fear of physical injury and Generalized anxiety.
|Table 1: Age and sex of the sample and distribution according to anxiety levels|
Click here to view
The mean scores across gender shows that female students scored much higher in total and all sub types of meausred anxiety. The total mean score was 19.66 ± 10.43 for male and 31.33 ± 12.86 for females). This pattern found across all subtypes i.e. seperation anxiety, social phobia, OCD, panic-agoraphobia, physical injury fear and generalized anxiety [Table 2]. Mann-Whitney U test revealed a significant difference in Spence total and subscale mean ranks between male and female students (P < 0.001), except in subgroup of obsession and compulsion scores [Table 3].
|Table 2: Distribution of sample according to gender(N=146; male=80, female=66)|
Click here to view
|Table 3: Sub scale scores across gender: Mann‑Whitney U test results on total sample (n=146; male=80; female=66)|
Click here to view
Further when data was analyzed as per child's perception of their parents, the mean total anxiety scores were much higher in authoritarian type of parenting (34.76 ± 13.84) in compared to democratic (21.21 ± 9.45) and permissive (20.82 ± 11.49). The mean ranks amongauthoritarian, democratic and permissive type of parenting was 101.49, 62.13 and 60.54 respectivly. Kruskal Wallis Test revealed a significant difference in Spence total (P < 0.001) and subscale of OCD, panic-agoraphobia, physical injury fear (P < 0.001) and P = 0.005 for generalized anxiety, P = 0.012 for seperation anxiety and P = 0.006 for social phobia [Table 4].
|Table 4: Sub scale's scores across child's perception of parenting (N=143; no response by 03 students; Authoritarian parenting=37, Democratic parenting=78, Permissive parenting=28)|
Click here to view
| Discussion|| |
Purpose of the present study was to assess the prevalence of overall anxiety symptoms and gender difference along with different subtypes of anxiety. We also recognized different parenting types from children perspective and total and different subtypes of anxiety across different parenting types.
Prevalence of anxiety in school students
With the primary aim of this study we found a prevalence of overall anxiety symptoms of 11% in our sample, in terms of scoring above cutoff on Spence anxiety scale. The prevalence of 11% in the present study is similar to Lal and Sethi  but differing from Deb et al.  who reported a prevalence of 19.13%. The high figures in the latter study could be due to the fact that they used the State Trait Anxiety Inventory (STAI) to assess anxiety. However the prevalence range of 5-17% for any anxiety disorders among children and adolescents was found across various epidemiological studies.  Regarding Indian context, a meta-analysis of Indian epidemiological studies about anxiety disorders estimated a prevalence of 18.2% - 22.7%,  whereas another review of Indian studies about prevalence rate of anxiety disorders in children and adolescents, reported a median prevalence of 8% with range of 2% to 24%.  The differing result of these investigations reflect different methodologies of these studies. However ours finding could be unique in terms of subjects limited to class VIII students, narrow age range 12.71 ± 3.53, setting of an urban English medium school, an affluent industrial city and use of the Spence anxiety scale a self-reporting questionnaire, in contrast to wide variations in other studies.
Gender differences in anxiety in school children
This study adds to the existing literature by its finding of gender difference in reported anxiety among children in school setting, girls reported higher anxiety on all anxiety subscales then boys, these finding are consistent with many of the previous studies. ,,,, However, another Indian study at Kolkata found a contrasting significant higher anxiety in boys (20.1%) as compared to girls (17.9%).  This could be due to variation in the samples under study, higher aged sample (13-17 years), inclusion of five Bengali medium schools and three English medium schools and finally the different tool like STAI for assessment of anxiety used in the latter study. 
Several explanations have been proposed for the observed gender difference in anxiety symptoms among children, these includes both biological and environmental factors  and gender roles, gender-role stress, social relationships, and gender differences in exposure to social adversity and socialization process.  Contrary to the theory of environmental influences Lewinsohn et al.  demonstrated that controlling for 15 psychosocial variables (i.e. self-reported daily hassles, major life events, self-consciousness, self-esteem, social self-competence, emotional reliance, coping skills, family social support, friends social support, social desirability, physical illness, self-rated health, obesity index, frequency of exercise, and lifetime of physical symptoms) did not eliminate the sex difference in anxiety symptoms and disorders. Based on his finding he concluded that female vulnerability to anxiety is associated with some type of genetic or biological difference between girls and boys rather than being purely determined by environmental factors.
Parenting types and anxiety
Data synthesized for a Meta analysis indicated that the connection between parenting and child anxiety is small in magnitude; However many studies addressed the issues of different types of parenting and its differing association with childhood anxiety.  In our study we found that most of the students (54.5%) considered their parents as democratic, 19.5% as permissive and 26% as authoritarian. We also found that children who perceive their parents as authoritarian scored significantly higher anxiety scores compared to children who perceived their parents as democratic or permissive. In fact out of 37 students who considered their parents as authoritarian 11 scored above cut off; whereas among the remaining 106 students, only 5 scored above cut off score. The association between child anxiety and parenting is often studied as a construct of parental control. Consistent with our study, two meta-analysis of 23 studies  and 47 studies  found a strong association between child anxiety and parental control and weaker association with parental rejection. However the analysis also found some relation between parent anxiety and parental control but the causal mechanisms of these associations have not been established.
The findings of this study highlight one of the causes of anxiety in children. In addition the findings can have therapeutic implications by focusing on making the parents aware of the deleterious effects of authoritarian parental control and also the fact that research indicates that children with parents having democratic parenting style are better adjusted.  The findings of the study also highlight the need of both anxiety prevention efforts for adolescents and mental health promotion efforts aimed at adolescents' parents. Schools offer an ideal setting for universal prevention activities where a large numbers of children and adolescents can be reached. , Additionally, the school environment is likely to facilitate the acquisition of competencies in Indian children as it is viewed as a place of learning.  At school adolescents can be taught how to manage stress and anxiety and can practice skills.  Mental health promotion with adolescents' parents is also essential. A "systematic, large-scale, multifaceted, and ongoing public health campaign to educate parents about adolescence" has been advocated by one of the world's leading researchers on parent-adolescent relationships.  Parent education is specifically required in India to deal with the phenomenon of educational pressure and the comparison of the performance of one's own child with the best ranked students. 
The limitations of the study include the use of a self-report measure that ensured the convenience of quick data collection, but the assessment was not supported with parents' or teachers' reports, as children may be less accurate at judging their own problems. Many parents may utilize a mixture of different parenting styles which was not assessed in this study. Individual child characteristics, such as personality and temperament that could be important factors in this context were also not assessed. Additionally culture specific screening tools are lacking for students at risk for anxiety disorders in India. The study was conducted in an urban English medium school. Hence these findings cannot be generalized to rural or Hindi medium schools. There is a need to develop and validate Indian tools for screening children of different socio-cultural backgrounds for anxiety disorders.
| Conclusion|| |
The prevalence of high anxiety was found to be 11% in class VIII students, and high anxiety in students was significantly associated with female gender and authoritarian parenting pattern as perceived by the child.
| References|| |
|1.||Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A. Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 2003;60:837-44. |
|2.||Bernstein GA, Borchardt CM. Anxiety disorders of childhood and adolescence: A critical review. J Am Acad Child Adolesc Psychiatry 1991;30:519-32. |
|3.||Boyd CP, Kostanski M, Gullone E, Ollendick TH, Shek DT. Prevalence of anxiety and depression in Australian adolescents: Comparisons with worldwide data. J Genet Psychol 2000;161:479-92. |
|4.||Malhotra S, Kohli A, Kapoor M, Pradhan B. Incidence of childhood psychiatric disorders in India. Indian J Psychiatry 2009;51:101-7. |
|5.||Hayward C. Methodological concerns in puberty-related research. In: Hayward C, editor. Gender differences at puberty. New York: Cambridge University Press; 2003. p. 1-14. |
|6.||Spence SH, Barrett PM, Turner CM. Psychometric properties of the spence children's anxiety scale with young adolescents. J Anxiety Disord 2003;17:605-25. |
|7.||Essau CA, Conradt J, Petermann F. Frequency, comorbidity and psychosocial impairment of anxiety disorders in German adolescents. J Anxiety Disord 2000;14:263-79. |
|8.||Ialongo N, Edelsohn G, Werthamer-Larsson L, Crockett L, Kellam S. The significance of self-reported anxious symptoms in first grade children: Prediction to anxious symptoms and adaptive functioning in fifth grade. J Child Psychol Psychiatry 1995;36:427-37. |
|9.||Ezpeleta L, Keeler G, Erkanli A, Costello EJ, Angold A. Epidemiology of psychiatric disability in childhood and adolescence. J Child Psychol Psychiatry 2001;42:901-14. |
|10.||Strauss CC, Frame CL, Forehand R. Psychosocial impairment associated with anxiety in children. J Clin Child Psychol 1987;16:235-9. |
|11.||Hibbert A, Fogelman K, Manor O. Occupational outcomes of truancy. Br J Educ Psychol 1990;60:23-36. |
|12.||Rubin KH. Socially withdrawn children: An "at-risk" population? In: Schneider BH, Rubin KH, Ledingham JE, editors. Children's peer relations: Issues in assessment and intervention. New York: Springer-Verlag; 1985. p. 125-39. |
|13.||Copeland WE, Shanahan L, Costello EJ, Angold A. Childhood and adolescent psychiatric disorders as predictors of young adult disorders. Arch Gen Psychiatry 2009;66:764-72. |
|14.||Roza SJ, Hofstra MB, van der Ende J, Verhulst FC. Stable prediction of mood and anxiety disorders based on behavioral and emotional problems in childhood: A 14-year follow-up during childhood, adolescence, and young adulthood. Am J Psychiatry 2003;160:2116-21. |
|15.||Chorpita BF, Barlow DH. The development of anxiety: The role of control in the early environment. Psychol Bull 1998;124:3-21. |
|16.||Poulton R, Milne BJ, Craske MG, Menzies RG. A longitudinal study of the etiology of separation anxiety. Behav Res Ther 2001;39,1395-410. |
|17.||Weiss DD, Last CG. Developmental variations in the prevalence and manifestations of anxiety disorders. The developmental psychopathology of anxiety. Oxford: Oxford University Press; 2001. p. 27-42. |
|18.||Deb S, Chatterjee P, Walsh K. Anxiety among high school students in India: Comparisons across gender, school type, social strata and perceptions of quality time with parents. Aust J Educ Dev Psychol 2010;10:18-31. |
|19.||Rapee RM. The potential role of childrearing practices in the development of anxiety and depression. Clin Psychol Rev 1997;17:47-67. |
|20.||van der Bruggen CO, Stams GJ, Bögels SM. Research review: The relation between child and parent anxiety and parental control: A meta-analytic review. J Child Psychol Psychiatry 2008;49:1257-69. |
|21.||Wood JJ, McLeod BD, Sigman M, Hwang WC, Chu BC. Parenting and childhood anxiety: Theory, empirical findings, and future directions. J Child Psychol Psychiatry 2003;44:134-51. |
|22.||McLeod BD, Wood JJ, Weisz JR. Examining the association between parenting and childhood anxiety: A meta-analysis. Clin Psychol Rev 2007;27:155-72. |
|23.||Rohner RP, Khaleque A, Cournoyer DE. Parental acceptance-rejection: Theory, methods, cross-cultural evidence, and implications. Ethos 2005;33:299-334. |
|24.||Muris P, Loxton H, Neumann A, du Plessis M, King N, Ollendick T. DSM defined anxiety disorder symptoms in South African youth: Their assessment and relationship with perceived parental rearing behaviors. Behav Res Ther 2006;44:883-96. |
|25.||Dwairy M, Achoui M, Abouserie R, Farah A. Parenting styles, individuation, and mental health of Arab adolescents. J Cross Cult Psychol 2006;37:262-72. |
|26.||Mason CA, Walker-Barnes C, Tu S, Simons J, Martinez, Arrue R. Ethnic differences in the affective meaning of parental control behaviors. J Prim Prev 2004;25:59-79. |
|27.||Spence SH. Structure of anxiety symptoms among children: A confirmatory factor-analytic study. J Abnorm Psychol 1997;106:280-97. |
|28.||Spence SH. A measure of anxiety symptoms among children. Behav Res Ther 1998;36:545-66. |
|29.||Lal N, Sethi BB. Estimate of mental ill health in children of an urban community. Indian J Pediatr 1977;44:55-64. |
|30.||Bernstein GA, Borchardt CM, Perwien AR. Anxiety disorders in children and adolescents: A review of the past 10 years. J Am Acad Child Adolesc Psychiatry 1996;35:1110-9. |
|31.||Chandrasekhara CR, Reddy VM. Prevalence of mental and behavioral disorders in India: A meta-analysis. Indian J Psychiatry 1998;40:149-57. |
|32.||Sharan P, Sagar R. The Need for National Data on Epidemiology of Child and Adolescent Mental Disorders. J Indian Assoc Child Adolesc Ment Health 2008;4:22-7. |
|33.||Crocetti E, Hale WW, FermaniA, Raaijmakers Q, Meeus W. Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in the general Italian adolescent population: A validation and a comparison between Italy and The Netherlands. J Anxiety Disord 2009;23: 824-9. |
|34.||Ogliari A, Citterio A, Zanoni A, Fagnani C, Patriarca V, Cirrincione R, et al. Genetic and environmental influences on anxiety dimensions in Italian twins evaluated with the SCARED questionnaire. J Anxiety Disord 2006;20:760-77. |
|35.||Essau CA, Muris P, Ederer EM. Reliability and validity of the Spence Children's anxiety scale and the screen for child anxiety related emotional disorders in German children. J Behav Ther Exp Psychiatry 2002;33:1-18. |
|36.||Birmaher B, Khetarpal S, Brent D, Cully M, Balach L, Kaufman J, et al. The Screen for Child Anxiety Related Emotional Disorders (SCARED): Scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry 1997;36:545-53. |
|37.||Ollendick TH, King NJ. Fears and their level of inference in adolescents. Behav Res Ther 1994;32:635-8. |
|38.||Carter R, Silverman WK, Jaccard J. Sex variations in youth anxiety symptoms: Effects of pubertal development and gender role orientation. J Clin Child Adolesc Psychol 2011;40:730-41. |
|39.||Shear MK, Feske U, Greeno C. Gender differences in anxiety disorders: Clinical implications. In: Frank E, editor. Gender and its effects on psychopathology. Washington DC: American Psychiatric Publishing Inc.; 2000. p. 151-65. |
|40.||Lewinsohn PM, Gotlib IH, Lewinsohn M, Seeley JR, Allen NB. Gender differences in anxiety disorders and anxiety symptoms in adolescents. J Abnorm Psychol 1998;107:109-17. |
|41.||van der Bruggen CO, Stams GJ, Bögels SM. Research review: The relation between child and parent anxiety and parental control: A meta-analytic review. J Child Psychol Psychiatry 2008;49:1257-69. |
|42.||McLeod BD, Wood JJ, Weisz JR. Examining the association between parenting and childhood anxiety: A meta-analysis. Clin Psychol Rev 2007:27:155-72. |
|43.||Kim K, Rohner RP. Parental warmth, control, and involvement in schooling: Predicting academic achievement among Korean American adolescents. J Cross Cult Psychol 2002;33:127-40. |
|44.||Masia-Warner, Nangle DW, Hansen DJ. Bringing evidence-based child mental health services to the schools: General issues and specific populations. Educ Treat Child 2006;29:165-72. |
|45.||Barrett PM, Pahl KM. School-based intervention: Examining a universal approach to anxiety management. Australian J Guid Counc 2006;16:55-75. |
|46.||Rambaldo LR, Wilding LD, Goldman ML, McClure JM, Friedberg RD. School-based interventions for anxious and depressed children. In: VandeCreek L, Jackson TL, editor. Innovations in clinical practice: A source book. Sarasota: Professional Resource Press; 2001. |
|47.||Steinberg L. We know some things: Parent-Adolescent relationships in retrospect and prospect. J Res Adolesc 2001;11:1-19. |
[Table 1], [Table 2], [Table 3], [Table 4]