Risk and protective factors in the development of subthreshold anxiety during early adolescence

Abstract

Abstract Background Subthreshold anxiety (STA) is a significant risk factor for developing anxiety disorders (AX), especially during adolescence. Identifying the risk and protective factors in early life is crucial for early prevention and intervention. However, there is limited research on this topic among early adolescents. Methods We studied 11876 early adolescents from the Adolescent Brain and Cognitive Development (ABCD) Study to investigate factors influencing the evolution of STA from ages 9–10 to 12–13. Outcomes included developing AX, persistent STA, and recovery from STA. 786 participants were identified as STA using Child Behavior Checklist (CBCL). We incorporated 31 diathesis-stress-related variables as predictors, encompassing demographics, mental and physical health, and environment, and employed logistic regression for modeling STA transitions. Results Compared to HCs, adolescents with STA have a 6.93 odds ratio (OR) for converting to AX in three years. Risk factors for conversion include psychiatric family history, behavior inhibition, depression, sluggish cognitive tempo, oppositional defiance, and sleep disturbance. Those maintaining STA experience fewer risk factors like behavioral inhibition, depression, somatic problems, sleep disturbance, and family conflict. Recovery from STA is challenging with psychiatric family history, prodromal psychosis, depression, and sleep disturbance. Sensation seeking and lack of premeditation are protective against STA or transitioning to AX. Conclusions Various modifiable and non-modifiable factors were identified for prognosis of STA in early adolescence. Managing sleep routines, encouraging sensation seeking, and reducing premeditation could help prevent adverse outcomes. By targeting these modifiable factors, it becomes feasible to intervene and prevent adolescents at high risk early in life.