1. Introduction
Anxiety is a common feeling or emotional symptom in normal people [1]. Pathological anxiety is a main symptom in anxiety disorders and a secondary symptom in several other mental illnesses [1]. Anxiety disorders are common psychiatric disorders with high lifetime prevalence rates of 30.5% for women and 19.2% for men. In recent years, the disease burden has been worsening worldwide, and anxiety disorders are among the top 25 leading causes of disability-adjusted life years (DALYs) in 2021 [2]. Nevertheless, approximately 75% of patients with anxiety disorders respond to treatment, indicating that this disorder is a highly treatable illness [3].
Previous longitudinal studies have shown that the experience of peer victimization in childhood has immediate as well as long-term effects on anxiety into adulthood [4,5,6,7]. van Oort and colleagues investigated the long-term effects of the pre-adolescent environment on subsequent anxiety states of subjects by conducting three separate surveys on the same subjects [6]. They reported that children who were victims of bullying victimization before adolescence showed higher long-term anxiety [6]. Peer victimization increases social anxiety in female adolescents [8]. Peer victimization experiences in childhood increase the risk of anxiety disorders in adulthood [9]. Peer victimization experienced in childhood and adolescence increases the likelihood of developing psychiatric disorders, including various anxiety disorders, in adulthood [5].
On the other hand, another factor associated with the experience of peer victimization is the nurturing attitudes of the parents or guardians [10]. Peer victimization is reportedly more commonly experienced by female adolescents whose parents’ nurturing attitudes during childhood were overprotective [11]. Our research group also showed that parental nurturing attitudes in childhood influence childhood peer victimization experiences, which influence negative life event evaluations in adulthood [12]. A meta-analysis reported that negative parenting, including childhood abuse, is associated with peer victimization, whereas positive parenting is protective against peer victimization [10]. Parker reported that some patients with anxiety disorders were found to have experienced overprotective parenting attitudes in childhood [13]. Therefore, although it is clear from the studies described above that nurturing attitudes in childhood are closely associated with peer victimization, and both are associated with anxiety, the mechanism of the associations of these three variables has not been reported to date.
Depressive rumination (DR) has been proposed as an inappropriate emotion regulation strategy common to patients with anxiety disorders or depression. DR is repeated and negative thinking about the depressive symptoms of oneself and their causes and outcomes [14,15,16,17]. DR also increases the risk of anxiety symptoms as well as depressive symptoms [15,18,19,20,21]. Furthermore, experimentally induced DR has been shown to elicit symptoms of anxiety [22]. Although it is known that peer victimization increases DR and that DR mediates the association between peer victimization and depressive symptoms, whether DR is involved in the association between peer victimization and anxiety symptoms remains unclear [23].
Our research group recently showed that peer victimization experienced in childhood increases DR and trait anxiety in adulthood [24]. Childhood abuse also increases DR and trait anxiety in adulthood [25]. Similarly, parental nurturing attitudes experienced in childhood influence DR and trait anxiety [26]. However, previous studies focused on trait anxiety as a personality characteristic and have not analyzed state anxiety symptoms, which is anxiety felt now and transiently. Therefore, although it is likely that childhood parenting attitudes and peer victimization are associated with DR and that DR further influences state anxiety symptoms, verification of such a relationship among these psychological factors is needed.
These above findings suggest that parental nurturing attitudes experienced in childhood affect peer victimization experiences in childhood, DR, and anxiety symptoms in adulthood [5,6,8,9,10,11,12,13,15,18,19,20,21,23,24,26]. They also suggest that peer victimization experiences in childhood affect DR and anxiety symptoms in adulthood, and that DR affects anxiety symptoms in adulthood. However, there are no reports on the associations of “parental nurturing attitudes experienced in childhood”, “peer victimization experiences in childhood”, “DR”, and “anxiety symptoms in adulthood”. How DR influences the effects of parental nurturing attitudes and peer victimization experiences in childhood on anxiety symptoms in adulthood remains unclear. We hypothesized that parental nurturing attitudes experienced in childhood would influence childhood peer victimization experiences and DR, and indirectly influence anxiety symptoms (state anxiety) in adulthood through influences on peer victimization experienced in childhood and DR. We chose structural equation modeling to investigate the interrelationships and influences of the four variables of parental nurturing attitudes experienced in childhood, peer victimization experienced in childhood, DR, and state anxiety symptoms in adulthood. This study was a cross-sectional survey, in which questionnaires on the above four variables were distributed to adult volunteers.
2. Materials and Methods
2.1. Subjects
This study is part of a larger study that surveyed adults for demographic information, psychiatric symptoms, mental status, physical status, and work status [24,25,27]. During 1 year from April 2017, questionnaires were distributed to 1237 adult volunteers through convenience sampling. They were recruited with flyers and word of mouth through our acquaintances at Tokyo Medical University. Since 2018, we have been intensively analyzing these large amounts of data and have published several papers. However, the overall analysis is not yet complete because the data are enormous. This is why we are working with data collected in 2017–2018. The inclusion criterion was being 20 years old or older. Exclusion criteria were (a) having concurrent severe physical diseases, and (b) having concurrent organic brain diseases. The subjects received an explanation that their participation in the study was based on their willingness to participate voluntarily, that they would not be disadvantaged if they did not partake, the information collected would be anonymized, and their personal information would not be disclosed to outside parties. A total of 597 (48.3%) adult volunteers gave written consent to participate in the study, but 21 of these subjects were excluded because of a large amount of missing data. Therefore, data from 576 subjects were used for the analysis. The questionnaires included those for demographic information, childhood experiences of parental nurturing attitudes, peer victimization experienced in childhood, DR in adulthood, and state anxiety in adulthood. The study was performed according to the 1964 Declaration of Helsinki (amended in 2013), and approved by the Research Ethics Review Board of Tokyo Medical University (study approval number: SH3502).
To conclude a causal association between childhood events and adulthood psychological measures, a long-term prospective study from childhood to adulthood, which would take several decades, is required. In addition, an objective assessment should be considered. This means that it is very difficult to study the association between parental nurturing attitudes, peer victimization, depressive rumination, and anxiety symptoms, and such a study would require an enormous amount of cost and time. This is why we chose a cross-sectional design for this study.
2.2. Questionnaires
2.2.1. State-Trait Anxiety Inventory Form Y (STAI-Y)
The STAI-Y is a self-report scale that evaluates trait anxiety and state anxiety [28]. This study used the subscale of state anxiety, which is a temporary anxiety response to anxiety-inducing situations, events, or objects. Twenty items for state anxiety were rated on a 4-point Likert scale. The Japanese version of the STAI-Y, which has been validated, was used in this study [29].
2.2.2. Ruminative Responses Scale (RRS)
The RRS is a self-report scale of 22 items, which measures the frequency of DR on a 4-point Likert scale [30]. The Japanese version of the RRS, which has been validated, was used in this study [31]. The total scores of the RRS were analyzed in this study.
2.2.3. Childhood Victimization Rating Scale (CVRS)
The CVRS is a self-administered questionnaire, which assesses the frequency and severity of childhood peer victimization experienced in the community and in school, on a 5-point Likert scale [24]. Scores on this scale are significantly correlated with neuroticism, trait anxiety, DR, and depression [24,27,32]. A total score of the 5 items was used; higher scores indicate more severe peer victimization in childhood.
2.2.4. Parental Bonding Instrument (PBI)
The PBI is usually used as an indicator of the characteristics of a parent–child relationship, and is a scale that was developed to assess parental nurturing attitudes experienced before the age of 16 years, from the child’s perspective [33]. Specifically, it consists of 12 “care factor” items and 13 “overprotection factor” items, with a total of 25 items. The care factor items measure attachment, warmth, empathy, closeness, etc., received from the parent, whereas the overprotection factor items measure manipulation, intrusion, excessive contact, infantile treatment, and interference with independent behavior, etc. The Japanese version of the PBI, which has been validated, was used in this study [34].
2.3. Data Analysis
Pearson’s correlation coefficient or t-test was used to analyze demographic information and questionnaires, using SPSS 28 software (IBM, Armonk, NY, USA). In addition, multiple regression analysis was conducted with the forced entry method, in which STAI-Y state anxiety was the dependent variable and the demographic and questionnaire data were independent variables. Multiple regression analysis was chosen to identify potential confounding variables for state anxiety. Two structural equation models were constructed, in which childhood experiences of parental nurturing attitudes (care and overprotection) influenced peer victimization experiences, peer victimization influenced DR, and then all factors influenced the severity of state anxiety in adulthood. The robust maximum likelihood estimation was used for structural equation modeling (Mplus version 8.5 software: Muthén & Muthén, Los Angeles, CA, USA). The root mean square error of approximation (RMSEA) and comparative fit index (CFI) were used as goodness-of-fit indices to make an overall judgment [35]. A CFI value of more than 0.95 and a RMSEA value of less than 0.08 were considered to indicate an acceptable model fit, and a CFI of more than 0.97 and a RMSEA of less than 0.05 were considered to indicate a good model fit. Standardized coefficients and direct and indirect effects in the structural equation models were calculated. For missing data, the imputation method was used.
Statistical significance was set at a p-value of less than 0.05.
3. Results
3.1. Demographic Information and STAI-Y State Anxiety, RRS, Victimization, and PBI Scores (Table 1 and Table 2)
Table 1 presents the demographic information and STAI-Y state anxiety, RRS, CVRS, and PBI scores of the 576 subjects. Table 2 shows the correlations and associations between these parameters and state anxiety symptoms, as expressed by the STAI-Y score. The STAI-Y state anxiety score was significantly higher for women, those who were employed, unmarried, with a past history of psychiatric illness, and those currently with a psychiatric illness, by the t-test. Living alone and currently having a physical disease were not associated with STAI-Y state anxiety. State anxiety scores on the STAI-Y were negatively correlated with education years, but were not significantly correlated with age. In addition, RRS total score and CVRS scale score were significantly positively correlated with STAI-Y state anxiety scores. Maternal and paternal care scores on the PBI showed significantly negative correlations with state anxiety severity, and maternal and paternal overprotection scores on the PBI showed significantly positive correlations with state anxiety severity.
3.2. Multiple Regression Analysis of STAI-Y State Anxiety (Table 3)
Results of the multiple regression analysis of state anxiety scores on the STAI-Y as the dependent variable are shown in Table 3. The independent variables were parenting attitudes (PBI), peer victimization (CVRS), DR (RRS), sex, age, years of education, marital status, past history of psychiatric illness, and current psychiatric illness. Three variables, namely, RRS total score, maternal PBI care score, and past history of psychiatric illness were significantly correlated with state anxiety scores. The association of the other factors with state anxiety was not statistically significant. The adjusted R2 was 0.252; the model accounted for 25.2% of the variation in state anxiety symptoms. Multicollinearity was ruled out.
Depressive rumination was the most potent variable influencing state anxiety, and other demographic variables did not influence state anxiety as much. Therefore, it is not necessary to consider demographic variables to a great extent in the analysis of structural equation modeling.
3.3. Structural Equation Modeling (Figure 1 and Figure 2)
Figure 1 and Figure 2 present the results of the direct and indirect effects of structural equation modeling, with state anxiety symptom severity as the dependent variable.
In Model 1, paternal and maternal care scores on the PBI constitute the latent variable of “parental care” (Figure 1). A CFI of 1.000 and RMSEA of 0.000 indicated a good fit.
Regarding direct effects, parental care on the PBI had significantly negative effects on childhood peer victimization, DR, and severity of state anxiety in adulthood (Figure 1A). In addition, childhood peer victimization had a significant positive effect on DR, but no direct effect on the severity of state anxiety. DR also had a significant positive effect on the severity of state anxiety.
Regarding indirect effects, parental care had no significant effect on state anxiety through childhood peer victimization (β = 0.000, p = 0.971) (Figure 1B). Parental care had a significant negative effect on DR in adulthood through childhood peer victimization (β = −0.069, p < 0.001), a significant negative effect on state anxiety through DR (β = −0.096, p < 0.001), and a significant negative effect on state anxiety through both childhood peer victimization and DR (β = −0.028, p < 0.001). In addition, childhood peer victimization had a significant positive effect on state anxiety through DR (β = 0.102, p < 0.001). The R2 for state anxiety was 0.251, and this model accounted for 25.1% of the variation of state anxiety.
Model 1 demonstrated that DR is involved in the effects of parental care and peer victimization experienced in childhood on state anxiety symptoms in adulthood.
In Model 2, paternal and maternal overprotection scores on the PBI constituted the latent variable of “parental overprotection” (Figure 2). A CFI of 0.994 and RMSEA of 0.000 indicated a good fit.
Regarding direct effects, parental overprotection had significantly positive effects on childhood peer victimization, DR, and severity of state anxiety symptoms in adulthood (Figure 2A). In addition, childhood peer victimization had a significant positive effect on DR, but no direct effect on state anxiety, and DR had a significant positive effect on state anxiety.
Regarding indirect effects, parental overprotection had no effect on state anxiety through childhood peer victimization (β = 0.003, p = 0.821) (Figure 2B). On the other hand, parental overprotection had a significant positive effect on DR through childhood peer victimization (β = 0.077, p < 0.001), and a significant positive effect on state anxiety through DR (β = 0.105, p < 0.001). Parental overprotection also had a significant positive effect on state anxiety symptoms through both childhood peer victimization and DR (β = 0.032, p < 0.001). In addition, childhood peer victimization positively influenced state anxiety through DR (β = 0.100, p < 0.001). The R2 for state anxiety was 0.229, and this model accounted for 22.9% of the variation in state anxiety.
Model 2 demonstrated the involvement of DR in the effects of parental overprotection and peer victimization experienced in childhood on state anxiety symptoms in adulthood.
4. Discussion
In this study, parental care experienced in childhood not only had a direct inhibitory effect on childhood peer victimization experiences, adulthood DR, and adulthood state anxiety, but also had an indirect inhibitory effect on adulthood state anxiety through the involvement of childhood peer victimization experiences and adulthood DR. This suggests that appropriate parental care attitudes may reduce the risk of peer victimization in childhood, which in turn may reduce DR in adulthood and consequently lower anxiety symptoms in adulthood. On the other hand, overprotective parenting in childhood was found to not only have a direct worsening effect on peer victimization experiences in childhood, adulthood DR, and adulthood state anxiety, but also had an indirect worsening effect on adulthood state anxiety through the involvement of childhood peer victimization experiences and DR. This suggests that overprotective parenting attitudes may increase the risk of peer victimization in childhood, which in turn may increase DR in adulthood and consequently increase anxiety symptoms in adulthood. The results of this study are the first to our knowledge to demonstrate that parental nurturing attitudes influence DR through their impact on peer victimization experiences in childhood and ultimately indirectly influence state anxiety in adulthood.
Several studies, including our previous study, have demonstrated that overprotective parenting attitudes have an adverse impact on childhood peer victimization experiences [11,12]. The results of our present study are highly consistent with these findings. It has been noted that overprotective nurturing tends to make children inexperienced in many ways, making them more likely to be shy, withdrawn, and timid [36]. In addition, overprotective nurturing makes it difficult for children to develop basic social skills, making them more likely to be dependent on their parents and unable to be independent. As a result, the acquisition of social skills and the ability to build relationships in groups will be negatively affected, and the child may not be able to smoothly build relationships in group situations, may become isolated in groups, and may have an increased risk of peer victimization [11,37]. On the other hand, appropriate parental nurturing care has been reported to increase children’s self-esteem and resilience [38,39,40]. Increased self-esteem and resilience indicate that children are able to demonstrate resilience and the ability to heal again after failing or being hurt. Inevitably, appropriate parental nurturing care will increase opportunities to learn social skills and group relationships, which may result in smoother relationships in group situations and a reduction in the risk of peer victimization [11,41].
It is known that when people try to avoid thinking about something (“thought suppression”) or distract themselves with another thought, they paradoxically activate that thought [42]. There is also a paradoxical process of “thought suppression”, in which the suppression of thinking about a specific something inversely leads to continually thinking about it [43]. One of the causes of DR is a paradoxical phenomenon in which attempts to suppress negative thoughts can, in turn, intensify negative thoughts [44]. Parental overprotection and low care, peer victimization in childhood, and other adverse childhood experiences are events that are difficult to accept, and it is thought that paradoxically, the suppression of thoughts to avoid thinking about painful events in past nurturing situations and peer victimization activates such thoughts, and the DR that results from these thoughts is amplified. Our previous studies in the adult volunteers reported that parental overprotection and low care, childhood peer victimization, and childhood maltreatment all enhanced DR [24,25,26]. It is noteworthy that in these three studies, high trait anxiety mediated the effects of adverse experiences in childhood on DR. As trait anxiety is strongly positively correlated with state anxiety, it makes sense that parental nurturing attitudes and peer victimization experiences led to increased state anxiety via DR in the present study [15,18,19,20,21].
In the present study, DR was positively correlated with state anxiety, suggesting that a strong tendency toward rumination elicits anxiety potentiation. Consistent with the results of the present study, previous studies have also reported that DR is strongly associated with anxiety symptoms [15,18,19,20,21,45,46]. Many of the subject’s ruminative thoughts reflect uncertainty about whether important situations are manageable or controllable, and uncertainty about whether one can control one’s environment has been explained as a mechanism for the association between rumination and anxiety [45]. As discussed in the previous section, parental nurturing attitudes in childhood and peer victimization experiences are antecedents of DR, but there have been no reports of DR involvement in the indirect effect of parental nurturing attitudes and peer victimization experiences in childhood on anxiety symptoms in adulthood, and to our knowledge, this is the first report showing such an association [23,24,25,26]. The strength of this study is its demonstration of DR involvement. In other words, adverse childhood experiences can influence anxiety symptoms in adulthood by enhancing trait anxiety and DR, as indicated in the present and previous studies, suggesting that it is necessary to assess trait anxiety and DR and to further confirm the presence of adverse childhood experiences in individuals who present with anxiety symptoms for clinical assessment and treatment [24,25,26].
This study has several limitations. The first limitation of this study is that it is based on retrospective survey data of the subjects’ past memories, and thus the results may be affected by memory bias or memory error. Second, as this is a cross-sectional study, verification by a long-term prospective study is necessary to conclude a causal association. Third, several psychological or social factors may influence depressive rumination and anxiety. Potential confounding variables for depressive rumination and anxiety should also be considered better to explain the unexplored variables in the structural equation model. In multiple regression analyses, demographic variables did not influence state anxiety and depressive rumination so much (Supplementary Table S1 for depressive rumination). However, other psychological or social factors as confounding variables should be examined in the future. Finally, structural equation modeling explains only a portion of the variability in anxiety symptoms (22.9 or 25.1%), meaning that other factors may play a role in this model but were not included in the study.
5. Conclusions
The results of this study suggest that appropriate parental care suppresses DR through reducing peer victimization experiences in childhood, and ultimately has an indirect inhibitory effect on state anxiety in adulthood through these suppressive effects. On the other hand, overprotective nurturing attitudes of the parents have a facilitative effect on DR through increasing peer victimization in childhood, and ultimately have an indirect facilitative effect on state anxiety in adulthood through these facilitative effects. These findings suggest that when we support patients with anxiety as a primary complaint, we can identify their support needs by assessing the parental attitudes they experienced during childhood, the presence or absence of peer victimization experiences, and DR, which will then enable us to provide appropriate therapeutic support, such as trauma care and cognitive behavioral therapy, as needed. This is a clinically meaningful suggestion because anxiety disorders are highly treatable psychiatric disorders through pharmacotherapy and psychological therapy. In addition, the fact that it was reconfirmed that parental attitudes have long-term effects on children suggests the necessity and importance of appropriate support and awareness-raising activities for parents who are raising children or who are considering raising children in the future.
Conceptualization, J.M., M.K. and T.I.; methodology, J.M., M.K., M.O., C.M., M.H. and T.I.; software, J.M., M.K. and T.I.; validation, J.M., M.K., M.O., C.M., S.I., R.N., Y.T., O.T., M.H. and T.I.; formal analysis, J.M., M.K., M.O., C.M., S.I., R.N., Y.T., O.T., M.H. and T.I.; investigation, J.M., M.K., M.O., C.M., S.I., R.N., Y.T., O.T., M.H. and T.I.; resources, J.M., M.K. and T.I.; data curation, J.M., M.K., M.O., C.M., S.I., R.N., Y.T., O.T., M.H. and T.I.; writing—original draft preparation, J.M., M.K., M.O., C.M., S.I., R.N., Y.T., O.T., M.H. and T.I.; writing—review and editing, J.M., M.K., M.O., C.M., S.I., R.N., Y.T., O.T., M.H. and T.I.; visualization, J.M., M.K. and T.I.; supervision, J.M., M.K. and T.I.; project administration, J.M., M.K. and T.I.; funding acquisition, J.M., M.K. and T.I. All authors have read and agreed to the published version of the manuscript.
The study was conducted in accordance with the 1964 Declaration of Helsinki (amended in 2013), and the protocol was approved by Ethics Committee of Tokyo Medical University Committee Reference number: SH3502, dated 26 October 2016.
Informed consent was obtained from all subjects involved in this study.
The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author.
We thank Nobutada Takahashi of Fuji Psychosomatic Rehabilitation Institute Hospital, Hiroshi Matsuda of Kashiwazaki Kosei Hospital, Yasuhiko Takita (deceased) of Maruyamasou Hospital, and Yoshihide Takaesu of Izumi Hospital for their collection of subject data. We thank Helena Popiel of the Center for International Education and Research, Tokyo Medical University, for editorial review of the manuscript.
The authors have read the journal’s policy, and the authors of this manuscript have the following competing interests: Jiro Masuya has received personal compensation from Otsuka Pharmaceutical, Eli Lilly, Astellas, and Meiji Yasuda Mental Health Foundation, and grants from Pfizer. Yu Tamada has received personal compensation from Otsuka Pharmaceutical, Sumitomo Pharma, Eisai, MSD, and Meiji Seika Pharma. Osamu Takashio has received personal compensation from EA Pharma, Eisai, Janssen Pharmaceutical, Kyowa Pharmaceutical Industry, Meiji Seika Pharma, MSD, Otsuka Pharmaceutical, Sumitomo Pharma, Viatris Pharmaceuticals Japan Inc., and Takeda Pharmaceutical. Takeshi Inoue has received personal compensation from Mochida Pharmaceutical, Takeda Pharmaceutical, Eli Lilly, Janssen Pharmaceutical, MSD, Yoshitomiyakuhin, Mitsubishi Tanabe Pharma, Meiji Seika Pharma, Lundbeck, Nippon Boehringer Ingelheim Co., and Viatris Pharmaceuticals Japan Inc.; grants and personal compensation from Shionogi, Eisai, Otsuka Pharmaceutical, Sumitomo Pharma, Daiichi Sankyo, and Kyowa Pharmaceutical Industry; and is a member of the advisory boards of Viatris Pharmaceuticals Japan Inc, Takeda Pharmaceutical, Nippon Boehringer Ingelheim Co., and Otsuka Pharmaceutical. All other authors declare that they have no actual or potential conflicts of interest associated with this study.
Footnotes
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![View Image - Figure 1. Results of the structural equation modeling with the parental attitude of ‘care’ experienced in childhood as the latent variable, and peer victimization in childhood, depressive rumination (RRS score), and state anxiety evaluated using the STAI-Y as the observed variables. The latent variable is shown as an oval, and the observed variables are shown as rectangles. The arrows with solid lines represent the statistically significant paths, and those with broken lines represent the nonsignificant paths. Direct effects (A) and indirect effects (B) between the variables are shown. In (B), the observed variables of paternal and maternal care have been omitted. The numbers show the standardized path coefficients. *** p [less than] 0.001.](https://media.proquest.com/media/hms/THUM/2/OID0c?_a=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%3D%3D&_s=6wMvPzADTAZH1gk1GH%2BwzyZ40zg%3D "View Image - Figure 1. Results of the structural equation modeling with the parental attitude of ‘care’ experienced in childhood as the latent variable, and peer victimization in childhood, depressive rumination (RRS score), and state anxiety evaluated using the STAI-Y as the observed variables. The latent variable is shown as an oval, and the observed variables are shown as rectangles. The arrows with solid lines represent the statistically significant paths, and those with broken lines represent the nonsignificant paths. Direct effects (A) and indirect effects (B) between the variables are shown. In (B), the observed variables of paternal and maternal care have been omitted. The numbers show the standardized path coefficients. *** p [less than] 0.001.")
Enlarge this image.Figure 1. Results of the structural equation modeling with the parental attitude of ‘care’ experienced in childhood as the latent variable, and peer victimization in childhood, depressive rumination (RRS score), and state anxiety evaluated using the STAI-Y as the observed variables. The latent variable is shown as an oval, and the observed variables are shown as rectangles. The arrows with solid lines represent the statistically significant paths, and those with broken lines represent the nonsignificant paths. Direct effects (A) and indirect effects (B) between the variables are shown. In (B), the observed variables of paternal and maternal care have been omitted. The numbers show the standardized path coefficients. *** p [less than] 0.001.
![View Image - Figure 2. Results of the structural equation modeling with the parental attitude of ‘overprotection’ in childhood as the latent variable, peer victimization in childhood, depressive rumination (RRS score), and state anxiety evaluated using the STAI-Y as the observed variables. The latent variable is shown as an oval, and the observed variables are shown as rectangles. The arrows with solid lines represent the statistically significant paths, and those with broken lines represent the nonsignificant paths. Direct effects (A) and indirect effects (B) between the variables are shown. In (B), the observed variables of paternal and maternal overprotection have been omitted. The numbers show the standardized path coefficients. * p [less than] 0.05, *** p [less than] 0.001.](https://media.proquest.com/media/hms/THUM/4/OID0c?_a=ChgyMDI1MDgzMDA3MDgxODg3Mzo2MzI1MTkSBzEzODMzMjMaCk9ORV9TRUFSQ0giDTIxNi43My4yMTYuMTUqBzUwNDY4NjcyCjMxODE2OTEyMTU6C0lubGluZUltYWdlQgEwUgZPbmxpbmVaA0lMSWIEVEhVTWoKMjAyNS8wMS8wMXIKMjAyNS8xMi8zMXoAggEgUC0xMDAwMDg0LTIwMTM5NS1TVEFGRi1udWxsLW51bGySAQZPbmxpbmXKAWdNb3ppbGxhLzUuMCBBcHBsZVdlYktpdC81MzcuMzYgKEtIVE1MLCBsaWtlIEdlY2tvOyBjb21wYXRpYmxlOyBDbGF1ZGVCb3QvMS4wOyArY2xhdWRlYm90QGFudGhyb3BpYy5jb20p0gESU2Nob2xhcmx5IEpvdXJuYWxzmgIHUHJlUGFpZKoCG09TOkVNUy1GdWxsVGV4dC1nZXRGdWxsVGV4dMoCD0FydGljbGV8RmVhdHVyZeICAU7qAgZzdW1tb27yAgD6AgFZggMDV2ViigMcQ0lEOjIwMjUwODMwMDcwODE4ODczOjE2MTQxMg%3D%3D&_s=xHBeFt05lkEz8U2Jp%2BgHRADDcWQ%3D "View Image - Figure 2. Results of the structural equation modeling with the parental attitude of ‘overprotection’ in childhood as the latent variable, peer victimization in childhood, depressive rumination (RRS score), and state anxiety evaluated using the STAI-Y as the observed variables. The latent variable is shown as an oval, and the observed variables are shown as rectangles. The arrows with solid lines represent the statistically significant paths, and those with broken lines represent the nonsignificant paths. Direct effects (A) and indirect effects (B) between the variables are shown. In (B), the observed variables of paternal and maternal overprotection have been omitted. The numbers show the standardized path coefficients. * p [less than] 0.05, *** p [less than] 0.001.")
Enlarge this image.Figure 2. Results of the structural equation modeling with the parental attitude of ‘overprotection’ in childhood as the latent variable, peer victimization in childhood, depressive rumination (RRS score), and state anxiety evaluated using the STAI-Y as the observed variables. The latent variable is shown as an oval, and the observed variables are shown as rectangles. The arrows with solid lines represent the statistically significant paths, and those with broken lines represent the nonsignificant paths. Direct effects (A) and indirect effects (B) between the variables are shown. In (B), the observed variables of paternal and maternal overprotection have been omitted. The numbers show the standardized path coefficients. * p [less than] 0.05, *** p [less than] 0.001.
Demographic characteristics, and STAI-Y (state anxiety), RRS, victimization, and PBI scores of the 576 subjects.
| Characteristic or Measure | Number or Mean ± SD |
|---|---|
| Age (years) | 41.6 ± 12.0 |
| Sex (men/women) | 249:327 |
| Years of education | 14.6 ± 1.8 |
| Employment status (employed/non-employed) | 562:10 |
| Current marital status (married/single) | 377:194 |
| Living alone (yes/no) | 114:453 |
| Current physical disease (yes/no) | 111:465 |
| Past history of psychiatric illness (yes/no) | 68:508 |
| Current psychiatric illness (yes/no) | 23:544 |
| STAI-Y score (state anxiety) | 41.5 ± 9.7 |
| RRS total score | 35.2 ± 11.4 |
| CVRS score | 2.4 ± 3.3 |
| PBI score | |
| Paternal care | 23.5 ± 8.2 |
| Paternal overprotection | 9.7 ± 7.0 |
| Maternal care | 28.0 ± 7.0 |
| Maternal overprotection | 9.7 ± 7.0 |
Data are presented as means ± standard deviations (SDs) or numbers. STAI-Y, State-Trait Anxiety Inventory Form Y; RRS, Ruminative Responses Scale; CVRS, Childhood Victimization Rating Scale; PBI, Parental Bonding Instrument.
Correlation of characteristics with STAI-Y (state anxiety) score (r) or effects on STAI-Y (state anxiety) score.
| Characteristic or Measure | Correlation with STAI-Y (State Anxiety) (r) or Effect on STAI-Y (State Anxiety) (Mean ± SD, t-Test) |
|---|---|
| Age (years) | r = 0.021, p = 0.614 |
| Sex (men/women) | Men (40.2 ± 9.4) vs. women (42.5 ± 9.8), p = 0.004 (t-test) |
| Years of education | r = −0.122, p = 0.003 |
| Employment status | Employed (41.6 ± 9.5) vs. non-employed (30.3 ± 8.4), p < 0.001 (t-test) |
| Current marital status | Married (40.5 ± 9.5) vs. single (43.5 ± 9.7), p < 0.001 (t-test) |
| Living alone (yes/no) | Yes (42.3 ± 10.1) vs. no (41.4 ± 9.6), p = 0.344 (t-test) |
| Current physical disease (yes/no) | Yes (42.4 ± 9.5) vs. no (41.3 ± 9.7), p = 0.262 (t-test) |
| Past history of psychiatric illness (yes/no) | Yes (46.5 ± 9.4) vs. no (40.8 ± 9.5), p < 0.001 (t-test) |
| Current psychiatric illness (yes/no) | Yes (48.6 ± 9.0) vs. no (41.1 ± 9.6), p < 0.001 (t-test) |
| RRS total score | r = 0.463, p < 0.001 |
| CVRS score | r = 0.185, p < 0.001 |
| PBI score | |
| Paternal care | r = −0.197, p < 0.001 |
| Paternal overprotection | r = 0.206, p < 0.001 |
| Maternal care | r = −0.276, p < 0.001 |
| Maternal overprotection | r = 0.228, p < 0.001 |
Data are presented as means ± standard deviations (SDs) or numbers. r = Pearson’s correlation coefficient. STAI-Y, State-Trait Anxiety Inventory Form Y; RRS, Ruminative Responses Scale; CVRS, Childhood Victimization Rating Scale; PBI, Parental Bonding Instrument.
Results of multiple regression analysis of STAI-Y score (state anxiety).
| Independent Variable | Beta | p-Value | VIF |
|---|---|---|---|
| CVRS score | 0.030 | 0.462 | 1.203 |
| RRS total score | 0.403 | <0.001 | 1.308 |
| Years of education | −0.068 | 0.129 | 1.403 |
| Current marital status | −0.026 | 0.532 | 1.200 |
| Past history of psychiatric illness | 0.093 | 0.034 | 1.348 |
| Current psychiatric illness | 0.020 | 0.657 | 1.353 |
| Age | 0.023 | 0.605 | 1.402 |
| Sex | 0.046 | 0.255 | 1.123 |
| PBI score | |||
| Paternal care | −0.010 | 0.852 | 1.955 |
| Paternal overprotection | 0.069 | 0.226 | 2.258 |
| Maternal care | −0.122 | 0.036 | 2.368 |
| Maternal overprotection | −0.060 | 0.312 | 2.441 |
Beta, standardized partial regression coefficient; VIF, variance inflation factor. Dependent variable: STAI-Y score (state anxiety). Twelve independent variables: age, sex (men = 0, women = 1), marital status (single = 0, married = 1), education years, past history of psychiatric illness (absence = 0, presence = 1), current psychiatric illness (absence = 0, presence = 1), RRS total score, Childhood Victimization Rating Scale (CVRS) score, PBI score (paternal care, paternal overprotection, maternal care, and maternal overprotection). Adjusted R2 = 0.252; F = 15.762; p < 0.001.
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Details
; Ito, Shunichiro 1 ; Nibuya, Rintaro 1 ; Tamada, Yu 2
; Takashio, Osamu 2 ; Honyashiki, Mina 1
; Inoue, Takeshi 1
1 Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan;
2 Department of Psychiatry, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi 193-0998, Japan;