Are Anxiety Disorders Environmentally Transferred From Mother to Daughter?

A cross-sectional family study sought to determine if parents’ transmission of anxiety is sex specific.

A cross-sectional family study published in JAMA Network Open found mother-daughter transference of the mother’s anxiety disorder to daughters, suggesting an environmental mechanism.

The Families Overcoming Risks and Building Opportunities for Well-being (FORBOW) study was conducted in Canada between 2013 and 2020. Families that had a parent with a mood disorder and at least 1 offspring aged 21 years and younger were evaluated for same- or opposite-sex co-occurrence of anxiety disorders in parent and offspring. Data were collected using semistructured interviews.

The participating offspring (N=398) comprised 203 girls or women aged mean 11.1 (SD, 3.7) years and 195 boys or men aged mean 10.6 (SD, 3.1) years. A total of 88.4% were White. Mothers (221) aged mean 39.8 (SD, 6.2) years and fathers (172) aged mean 42.0 (SD, 7.1) years participated in this study.

Among the mothers, 45.7% had 1 or more anxiety disorders, 42.1% were diagnosed with major depressive disorder (MDD), 20.4% with bipolar disorder (BD), and 5.0% with schizophrenia. For the fathers, 24.4% had MDD, 23.3% had anxiety disorders, 9.9% had BP, and 4.1% had schizophrenia.

Among the offspring, 27.1% had anxiety disorders, the rates of which increased with age from 14.1% in children aged <9 years to 51.8% in adolescents aged >15 years. Rates of anxiety disorders were similar between boys and men (24.1%) and girls and women (30.1%). Rates of anxiety were lower in the offspring of parents without an anxiety disorder (23.7%) compared with the offspring of 1 parent with an anxiety disorder (28.1%) or both parents with an anxiety disorder (41.4%).

The likelihood of an offspring having an anxiety disorder increased with the number of parental anxiety diagnoses (odds ratio [OR], 2.22; 95% CI, 1.38-3.57; P =.001).

For other parental diagnoses, offspring anxiety rates were lowest for parental schizophrenia (6.3%) and highest for parental BP (36.0%). Overall, the likelihood of an offspring having an anxiety disorder increased with the number of parental mood disorders (OR, 1.75; 95% CI, 1.11-2.74; P =.02).

Among the subset of children (n=299) who had both parents participating, offspring anxiety was more likely if their same-sex parent had anxiety (OR, 2.85; 95% CI, 1.52-5.34; P =.001) but not if their opposite-sex parent had anxiety (OR, 1.51; 95% CI, 0.81-2.81; P =.20).

This trend was only significant for mother-daughter (OR, 3.30; 95% CI, 1.43-7.59; P =.005) but not father-son (OR, 2.18; 95% CI, 0.89-5.33; P =.09) pairs. Similarly, a same-sex parent without anxiety decreased risk for offspring anxiety (OR, 0.38; 95% CI, 0.22-0.67; P =.001) but, the same trend was not observed for opposite-sex pairs (OR, 0.96; 95% CI, 0.56-1.63; P =.88).

The major limitation of this study was the young age of children, as anxiety disorders tend to be diagnosed at older ages.

The study authors concluded, “This study’s findings suggest that the intergenerational transmission of anxiety disorders is largely accounted for by the transmission from the same-sex parent. Treating parents with anxiety disorders may protect their offspring, especially their same-sex offspring, from developing an anxiety disorder regardless of parental mood disorder.”


Pavlova B, Bagnell A, Cumby J, et al. Sex-specific transmission of anxiety disorders from parents to offspring. JAMA Netw Open. 2022;5(7):e2220919. doi:10.1001/jamanetworkopen.2022.20919