Journal of Child & Adolescent

Behavior Caraveo, J Child Adolesc Behav 2014, 2:2

http://dx.doi.org/10.4172/jcalb.1000131

Research Article Open Access

Familial Risk Across Three Generations and Psychosocial Correlates for

Developing Psychopathology in a Changing World
Jorge Javier Caraveo*
Instituto Nacional de Psiquiatria “Ramion de la Fuente Muniz”, Direccion de Investigaciones Epidemiológicas y Psicosociales, Calzada Mexico-Xochimilco 101, San
Lorenzo Huipulco, Tlalpan, Mexico
*Corresponding author: Jorge Javier Caraveo, Instituto Nacional de Psiquiatria “Ramion de la Fuente Muniz”, Direccion de Investigaciones Epidemiológicas y
Psicosociales, Calzada Mexico-Xochimilco 101, San Lorenzo Huipulco, Tlalpan, Mexico, Tel: 52 55 4160 5169; E-mail: [email protected]
Received date: January 2, 2014, Accepted date: April 08, 2014, Published date: April15, 2014
Copyright: © 2014 Caraveo JJ. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background: Human development is a highly complex, environment-dependent process including mental health
and psychopathology among its outcomes. Thus, it needs to be studied comprehensively in order to identify
correlations and interactions among different biological, economical and psychosocial variables across time and
generations.

Objective: Is familial psychopathology risk across three generations significantly associated with ongoing
psychosocial variables reported by probands?

Methods: The study was designed as a household survey on a representative sample of the adult population
aged 18 - 65 years in Mexico City. The family-history method was used to obtain information about psychiatric
antecedents on their parents and a validated screening instrument was used to evaluate caseness in their offspring.
Lifetime prevalence of psychiatric disorders on probands was evaluated using the Composite International
Diagnostic Interview. Morbid risk in terms of the odds ratio and prevalence ratio were calculated using logistic
regression with fixed effects as well as with generalized estimating equations (GEE) population-averaged models
with an exchangeable structure. Aditionally, the population attributable risk percent was also calculated for selected
variables associated with the outcome in the complete models.

Results: The strenght of the association of familial psychiatric antecedents is moderate between generations on
either direction: backwards in regards of proband’s parents or downwards in regards of their children. However,
when interaction between the two previous generations was considered, the strenght of the association was higher,
crude OR=7.8, and showing significant variations when controlling for the effect of the rest of the variables and
especially for probands’ psychosocial correlates. The population attributable risk percent for these variables across
generations is sometimes higher than the obtained for familial risk.

Conclusions: Findings suggest that besides psychiatric familial risk, socioeconomial and psychodynamic risk
factors have been interacting across time and generations contributing to the high prevalence of psychiatric
disorders recently reported on youth Mexican population.

Keywords: Socioeconomic; Family stress; Psychopathology; Three genetic, biological, and psychosocial characteristics— and their
generation study; Cultural characteristics; Diathesis-stress; Childhood; attendant risk—are transmitted from one generation to the next, an
Adolescence; G x E; CBTD : Cognitive-behavior therapy for depressed. intergenerational mediation model may best characterize the
development of psychopathology in general as well as for specific
Introduction disorders (i.e., G1, G2, and G3).

All common psychiatric disorders where a genetic basis is suspected The continuity of mental health and adjustment problems is not
correspond to the so called “complex disorders”. These are the result limited to two generations as it has been documented to occur at least
of the interaction between genetic liability and environmental factors. across three generations [3-11]. However, a major unanswered
Both epidemiologist and genetic scientists are interested in these question is whether the relationship between multiple mental health
disorders but there is a need for a common methodology. problems across generations is a result of the continuity of underlying
Intergenerational studies have become of special interest, as heritable problems that are genetically transmitted across generations, or is the
risk and early childhood biological markers of emotional disorder may result of gene-environmental interactions [12].
be passed across consecutive generations (e.g., temperamental Human development is a highly complex, environment-dependent
variables, elevated cortisol levels) [1, 2]. In a like manner, psychosocial process including mental health and psychopathology among its
characteristics that increase the risk of emotional and conduct outcomes. Cicchetti [13] signaled that in order to develop a thorough
disturbances may be passed from parent to child via processes such as and comprehensive understanding of maladaptive and adaptive
modeling and direct communications [3]. To the extent that these functioning, it is important that developmental scientists increasingly

J Child Adolesc Behav Volume 2 • Issue 2 • 1000131

ISSN:JCALB, an open access journal JCALB, an open access journal
Citation: Caraveo JJ (2014) Familial Risk Across Three Generations and Psychosocial Correlates for Developing Psychopathology in a
Changing World. J Child Adolesc Behav 2: 131. doi:10.4172/jcalb.1000131

Page 2 of 8

incorporate multiple levels of analysis and multiple domains into their 225% and significant reduction of actual acquisitive power of 35%
research investigations. Gene-environment correlations (rGE) concern [21].
genetic influences on individual variations in people’s exposure to
Hence, the objective for this paper is to answer the following
particular sorts of environments. There are several types of rGE that
questions:
play a substantial role in influencing environmental risk exposure, but
their impact is best understood through the effects of parent and child Are socio-demographic characteristics such as gender, age,
behaviors in shaping and selecting environments [14]. Studies household income and proband’s labor status associated with the
exploring the role of family social economic status (SES) as a development of psychopathology between and across generations?
moderator of genetic and environmental influences on general
Are probands’ psychosocial characteristics associated with the
cognitive ability have provided evidence that socioeconomic
development of psychopathology between and across generations?
circumstances differentially impact the heritability of cognitive
abilities [15]. Furthermore, as SES is correlated with differences in life Is familial psychopathology risk across three generations
stress and family resources (e.g. fewer financial resources increases significantly associated with ongoing psychosocial variables reported
parental stress, negatively affecting child development through its by probands?
effects on parenting behavior), Hackman et al [16] suggested that
prenatal factors, parent-offspring interactions and cognitive Materials and Methods
stimulation partly underlie the effects of SES, corroborating the
hypothesis of the family stress model, whereby economic disadvantage The study was designed as a household survey on a representative
affects children’s well-being through its effects on the parent. Family sample of the adult population aged 18 - 65 years in Mexico City [22].
income and other measures of socioeconomic status (SES) are public Briefly, a standardized assessment for adults’ lifetime prevalence of
health indicators closely related to health in general as well as with psychiatric disorders was obtained via an amended version of the
developmental outcomes in children [17]. Differences in families Composite International Diagnostic Interview, CIDI. 1.1. The ICD-10
across the continuum of SES may create different experiences of stress diagnostic categories included were: Anxiety disorders (i.e.,
and environmental complexity, potentially affecting agoraphobia, social phobia, specific phobias, generalized anxiety, panic
neuropsychological development, cognition and mental health as a and obsessive-compulsive disorder), Affective disorders (i.e.,
whole. Stress and environmental conditions are two primary depressive episodes, dysthymia, hypomania and mania), as well as
experiential influences on brain development as well for psychological Substance Use disorders (including alcohol, sedatives, tranquilizers,
development. For example, a recent report found a direct negative stimulants, analgesics, inhalants, marijuana, cocaine, hallucinogens
effect of financial resources on grey matter cerebral volume and total and heroin).
cerebral volume [18]. Response rate was 60.4%. The total sample size was 1932 adult
As most of the studies published are based on Caucasian subjects (probands, Generation 2). In addition to the CIDI, all
populations and in developed countries, there is the need for data respondents provided information on the psychiatric history of their
from studies in other countries with different ethnic, cultural and parents (Generation 1) about anxiety, affective and substance-use
socio-economic conditions. A distinguishing characteristic of the disorders following the Family-history research criteria [23-25]. Also,
developing world is the fast pace of social change from one generation 925 respondents with children aged 4-16 years living in the same
to the next in terms of economic conditions, communication, household were interviewed (providing data about 1686 children and
globalization, changing gender roles, secularization, weakening family adolescents, Generation 3) using a standardized screening
ties, improvements in educational attainment levels but there are still questionnaire for assessing psychopathology, the Brief Screening and
unfavorable economic conditions for many, all of which may have a Diagnostic Questionnaire (CBTD for its initials in Spanish). The
profound effect upon exposure to childhood adversities [19]. A recent CBTD is a 27-item questionnaire answered by the parents of the child,
study on Mexican youth population [20] found that almost 40% of which explore symptoms frequently reported as motives for seeking
adolescents reported a 12-month disorder, and the difference between attention at the outpatient mental health services. Presence of the
these results and the 25% median prevalence estimate in developed symptom requires that each item has to be reported as “frequently”
regions was discussed in terms of the accelerated rate of social change presented. The internal consistency of the questionnaire showed a
and social adversity. Cronbach’s alpha of 0.81, range: 0.76 to 0.85 (26). Diagnostic
algorithms in order to define probable DSM-IV disorders in children
Several countries have experienced notable economical adversities were created based on data from this epidemiological study [27].
with potential impact for the mental health status on their populations
in recent years. The goal of the present paper is to bring out For children and adolescents, caseness was defined based on the
information that may contribute to a better understanding of how questionnaire score for those at the 9th decil and with 5 or more
socioeconomical changes correlate with mental health outcomes in symptoms [26]. Concurrent validity with any DSM-IV diagnosis using
populations experiencing rapid economical adjustments, using data the E-MiniKid standardized interview showed a positive predictive
from a sample collected among the Mexican population during a year value of 88% (95% [confidence interval] CI: 83.7%, 91.5%) and the
of significant social and economic turmoil. Area under the Curve (AUC) obtained by Receiver Operating
Characteristic Curves (ROC) analysis was 0.78 (95% CI: 75%, 81%)
The adoption of the neoliberal economic model in Mexico in the [28].
early 1990s induced several social adjustments and disparities. Six
months before the field-work of this study began, in 1995, the greatest To estimate the familial morbid risk for children and adolescents,
Mexican financial crisis occurred. The peso-to-dollar exchange rate interaction of familial psychopathology across generations was defined
increased from 3.49 to 9.42 pesos per dollar, with an inflation rate of as follows: Psychiatric history only in grandparents (G1); psychiatric

J Child Adolesc Behav Volume 2 • Issue 2 • 1000131

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Citation: Caraveo JJ (2014) Familial Risk Across Three Generations and Psychosocial Correlates for Developing Psychopathology in a
Changing World. J Child Adolesc Behav 2: 131. doi:10.4172/jcalb.1000131

Page 3 of 8

history only in proband (mother or father, G2); psychiatric history on As a multi-nominal sampling was used, and the odds ratios are
both previous generations (G1 and G2). always an over-estimation of the real population’s relative risk, GEE
population-averaged analysis with Poisson regression was performed
Analyses were carried out controlling for the effect of different
based on the results of the most complete previous models (31) in
potential confounding variables. The first group included: proband’s
order to obtain prevalence ratios. Also, as the data were representative
gender and age, children’s gender and age, proband’s labor status, and
of the population and a wide comprehensive approach of psychosocial
household income. The estimated household income was divided into
variables was included, the population attributable risk percent was
5 levels: 26.04% were at the bottom, 27.35%, 26.09%, 16.94% in
also obtained for selected variables from the complete models using
subsequent levels, and only 3.6% at the top. The second group
the following equation:
included the following proband’s psychosocial variables: relationship
with spouse, stress over work, couple’s total work hours per week, PAR%= (Pe) (RR – 1) x 100
worries between home and work, perception of family support (not
1 + (Pe) (RR – 1)
living at the same household), perception of community support, own
health’s perception, and social isolation. On these, the survey included Where Pe is the exponentiated prevalence prediction obtained from
specific sections with questions and scales that were used by Dr. the model. The relative risk, RR, is the ratio in the exposed population
Kessler at the first National Co-morbidity Study and described to the risk in the unexposed population. The population attributable
elsewhere [29]. Scores, arranged so that a higher punctuation indicated risk percent indicates the percentage of total risk that is due to
more adversity, were converted into dummy variables using quartiles. significant variables associated with the outcome [32].
Analyses were done using the Stata 12.0 program. Variance and
confidence interval estimation accounted for the complex stratified Results:
sampling of the survey, as well as for the clustering by family units that Characteristics of the sample are shown on Table 1. There were
has been extensively described elsewhere [7, 29]. 1932 probands (G2), 45.1% of whom were males; overall, 28.6% met
Morbid risk in terms of the odds ratio were calculated using logistic caseness criteria. Probands reported data on 2743 of their parents
regression with fixed effects as well as with generalized estimating (G1), 48.8% corresponding to males; and 23.6% meeting caseness
equations (GEE) population-averaged models with an exchangeable criteria. There were 925 probands who had children 4-16 years old, for
structure. GEE is an iterative procedure, using quasi-likelihood to a total of 1686 children and adolescent data reported (G3), 51.3% of
estimate the regression coefficients; the relationships between the whom were males; and with 16% of G3 meeting caseness criteria for a
variables of the model at different time-points are analyzed mental problem. Probands’ mean age was 34.8 years old, 55% had one
simultaneously. Because the repeated observations within one subject offspring, 30.5% had two, 11.3% had three, and 3.2% had up to six
are not independent of each other, a correction must taken into offspring. Children mean age was 9.7 years; and the distribution by age
account for these within-subject correlations choosing a correlation groups was as follows: 4–5 years old 16.3%, 6-8 years old 25.5%, 9-12
structure. In an exchangeable structure, as used in this study, the years old 30.9%, and 13-16 years old 27.4%.
correlations between subsequent measurements are assumed to be the
same, irrespective of the length of the time interval [30].

Males % Females % Total Cases % Non cases %

Probands 871 45.1 1061 54.9 1932 552 28.6 1380 71.4

(Gen 2)

Grandparents (Gen 1) 1339 48.8 1404 51.2 2743 647 23.6 2096 76.4

Probands (Gen 2) with 381 41.2 544 58.8 925 292 31.6 633 68.4
offspring aged 4 to 16
years

Children and 865 51.3 821 48.7 1686 269 16 1416 84

adolescents (Gen 3)

Table 1: Sample Characteristics

The results on Table 2 show that the strength of the association Model 1 Model 2 Model 3
between any psychiatric antecedents in the previous generation (G1)
and the presence of psychopathology on probands (G2) did not vary OR p OR P OR p
considerably across models with progressive inclusion of covariates.
95% CI 95% CI 95% CI
Females were less likely to report any lifetime psychopathology.
Probands’ on-going correlates significantly associated with Non cases 1 1 1
psychopathology were tension over work, perceiving less support from
family (not living at the same household) as well as poorer perception Any familial 2.2 <0.001 2.5 <0.001 2 <0.001
psychiatric
of owns health. antecedents 1.6, 3.2 1.8, 3.6 1.4, 2.7

J Child Adolesc Behav Volume 2 • Issue 2 • 1000131

ISSN:JCALB, an open access journal JCALB, an open access journal
Citation: Caraveo JJ (2014) Familial Risk Across Three Generations and Psychosocial Correlates for Developing Psychopathology in a
Changing World. J Child Adolesc Behav 2: 131. doi:10.4172/jcalb.1000131

Page 4 of 8

Female 0.5 <0.001 0.3 <0.001 1.8, 4.0 1.5, 3.3

0.3, 0.6 0.2, 0.5 Daughter 0.7 0.005 0.6 0.002

Stress over 1.7 0.019 0.5, 0.9 0.5, 0.8

work
1.1, 2.6 Children’s Age 1.2 0.015 1.2 0.033

Perception of 1.5 <0.001 1.0, 1.3 1.0, 1.3

support by
non-nuclear 1.2, 1.7 Perception of 1.2 0.014
family support by

Perception of 1.4 <0.001 non-nuclear family 1.1, 1.5

health status
1.2, 1.7 Perception of 1.2 0.034
community support
No. 1682 1653 1551 1.0, 1.4
observations
Perception of 1.2 0.035
F 21.23 9.27 10.47 health status
1.0, 1.4
Gl 1 4 12
Tension over work 1.2 0.452
P 0.0001 0.0001 0.0001
0.8, 1.7
Adjusted for None a a, b
possible No. observations 1682 1652 1553
confounding
variables ** X2 42.29 84.4 97.12

gl 1 7 14
Table 2: Association* between familial psychiatric antecedents (Gen 1)
and proband’s psychopathology (GEN 2) and psychosocial correlates. p <0.001 <0.001 <0.001

*Logistic Regression with fixed effects (“classic”). Adjusted for None a a, b

possible
**a) proband’s gender and age, proband’s labour status, and confounding
variables **
household income; b) proband’s psycho-social variables: relationship
with spouse, stress at work, couple’s total work hours per week,
worries between home and work, perception of family support (not Table 3: Association* between psychopathology on GEN 3 and
living at the same household), perception of community support, own proband’s psychiatric antecedents (Gen 2) and psychosocial correlates
health’s perception, and social isolation.
*Logistic Regression with generalized estimated equations
Table 3 conveys the odds ratio across different models indicating
**a)
proband’s gender and age, children’s gender and age, proband’s
the strength of the association between probands’ psychiatric disorders
and psychopathology in their offspring. Here, the estimated labour status, and household income; b) proband’s psycho-social
association was higher than the crude Odds Ratio when controlling for variables: relationship with spouse, stress at work, couple’s total work
demographic variables, but it was practically the same when further hours per week, worries between home and work, perception of family
controlling for probands’ psychosocial characteristics. Notice that support (not living at the same household), perception of community
main effects rely on psychiatric familial antecedents as well as in support, and own health’s perception.
female gender. Among probands’ psychosocial variables, poorer The strength of the association between psychopathology in the
perception of community support as well as from the non-nuclear offspring (G3) and the interaction with familial psychopathology
family and worse perception of owns health were significantly across generations, controlling for the effect of socio-demographic
associated with report of psychopathology in their children. variables as well as for on-going psychosocial correlates at the time of
the study, are shown in Table 4. The odds ratio were higher when
Model Model Model
1 2 3 there were psychiatric familial antecedents on both previous
generations and controlling for sociodemographic variables. When
OR p OR p OR p proband’s psychosocial correlates were further adjusted for, the odds
ratio dimished notably, although it increased for G1 and especially for
95% CI 95% CI 95% CI
G2. Proband’s gender was associated with psychopathology in the
Non cases 1 1 1 offspring on the second model, but as other variables were
incorporated to the analysis, the observed significant association
Proband’s 2.7 0.001 3.5 <0.001 2.7 <0.001 vanished. The estimated household income that was inversely
psychopathology
2.0, 3.7 2.5, 4.9 1.9, 3.9 associated (Model 3, p=0.039) became no longer significant (Model 4,
p= 0.234) Psychosocial correlates significantly associated with the
Mother 2.7 <0.001 2.2 <0.001 report of psychopathology in the offspring indicated that proband’s

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ISSN:JCALB, an open access journal JCALB, an open access journal
Citation: Caraveo JJ (2014) Familial Risk Across Three Generations and Psychosocial Correlates for Developing Psychopathology in a
Changing World. J Child Adolesc Behav 2: 131. doi:10.4172/jcalb.1000131

Page 5 of 8

tension over work as well as less perceived support from family (not Complementing results, the prevalence ratio of any psychiatric
living at the same household) were important variables in the process. disorder in the probands for developing psychopathology in their
offspring (middle Table 5) was slightly higher than in the previous
Antecedents Model 1 Model 2 Model 3 Model 4 analysis, although the population attributable risk percent was also
OR (95% OR (95% OR (95% OR (95% CI)
slightly lower. Notably, perceiving less support from family (not living
CI) CI) CI) at the same household) contributed up to 64%in the worst situations.
Tension over work was not significantly associated with the outcome
G1 2.9 (1.5, 2.7 (1.4, 2.9 (1.4, 3.2 (1.5, 6.5) and its contribution in the worst cases was similar to the percent
5.8) 5.4) 5.9)
obtained for the lower population attributable risk percent between G1
G2 2.4 (0.9, 2.6 (1.0, 2.8 (1.1, 3.5 (1.3, 9.2) and G2.
6.0) 6.6) 7.3)
Finally, familial risk for developing psychopathology across
G 1 and G 2 7.8 (3.9, 8.7 (4.3, 9.5 (4.6, 6.6 (2.8, 15.5) generations was higher on the third one when there were psychiatric
15.4) 17.4) 19.3) antecedents on both previous generations explaining 36% of the
population atributable risk. The prevalence ratios of psychosocial
Mother 2.2 (1.2, 1.9 (0.9, 1.6 (0.8, 3.5)
4.0) 3.7) correlates - tension over work and less perceived support from family -
not living at the same household- were both found to be highly
Household income 0.8 (0.6, 0.8 (0.6, 1.1) contributing as shown by the population attributable risk percent. Less
1.0)
worries between home and work showed a relatively little protective
Tension over work 2.2 (1.2, 4.2) effect (bottom Table 5).

Perception of 1.4 (1.1, 2.0) Generations/Variables Prevalence Population

support by non- ratio attributable
nuclear family risk %
95% CI
Worries between 0.5 (0.3, 0.9)
home and work In G2 by G1

Observations 739 739 728 699 Any psychiatric disorder 1.6 ( 1.2, 2.0) 20.8

Groups. 419 419 413 397 Females 0.5 (0.4, 0.6) -14.6

X2 35.26 40.29 44.04 73.48 Tension over work 1.3 (1.1, 1.5) 15.4 to 34.4*

gl. 3 7 9 16 Perception of support by non-nuclear family 1.3 (1.1, 1.4) 11.4 to 26.2*

P <0.001 <0.001 <0.001 <0.001 Perception of health status 1.2 (1.1, 1.4) 9.5 to 18.7*

Adjusted for None a, b, c,d a, b, c, d, a, b, c, d, e, f, In G3 by G2

confounding e, f psychosocial**
variables * Any psychiatric disorder 2.1 ( 1.6, 2.8) 17.1

Mother 1.8 (1.3, 2.5) 12.9

Table 4: Association* between psychopathology on Gen 3 and
antecedents of psychiatric disorders on previous generations and Female children 0.7 (0.5, 0.8) -4.6
psychosocial correlates.
Children´s age 1.1 (1.0, 1.3) 2.5 to 7.1**
**Logistic Regression with generalized estimated equations Perception of support by non-nuclear family 1.2 (1.0, 1.4) 4.3 to 64.0*
a) proband’s sex; b) children’s sex; c) children’s age; d) proband’s
Perception of community support 1.1 (1.0, 1.3) 1.3 to 12.2*
age; e) socio-economic level; f) proband’s work status;** proband’s
psychosocial variables: relationship with spouse, stress over work, Perception of health status 1.1 (1.0, 1.3) 8.2 to 18.4*
couple’s total work hours per week, worries between home and work,
Tension over work 1.2 (1.0, 1.5) 2.7 to 17.3*
perception of family support (not living at the same household),
perception of community support, own health’s perception, and social In G3 across generations
isolation.
Only in grandparents 2.7 (1.4, 5.0) 18.4
Familial risk for developing psychopathology between and across
generations in terms of the prevalence ratios and population Only in father or mother 2.9 (1.3, 6.6) 15.4
attributable risk percent for each of the significant variables associated
On both previous 4.6 (2.3, 9.4) 36
with the outcome on previous analyses, are presented on Table 5.
Between probands and their parents, one fifth of the total risk was Tension over work 1.7 (1.1, 2.8) 1.8 to 44.0*
attributable to psychopathology in the previous generation. However,
psychosocial variables had considerably high attributable risks, Perception of support by non-nuclear family 1.4 (1.1, 1.7) 4.2 to 28.3*
specially for tension over work and perceiving less support from non-
nuclear family, which exceeded the population attributable risk of
familial psychopathology in the highest quartiles (top of Table 5).

J Child Adolesc Behav Volume 2 • Issue 2 • 1000131

ISSN:JCALB, an open access journal JCALB, an open access journal
Citation: Caraveo JJ (2014) Familial Risk Across Three Generations and Psychosocial Correlates for Developing Psychopathology in a
Changing World. J Child Adolesc Behav 2: 131. doi:10.4172/jcalb.1000131

Page 6 of 8

Worries between home and work 0.6 (0.4, 0.9) -1.9 to -4.3 On one hand, perception of available support from family and from
other persons in the social networks has been identified as an
important factor helping people cope with their problems, although
Table 5: Prevalence ratio and population attributable risk for
studies have not confirmed that support actually exists; consequently,
psychopathology between and across generations.
the answers to these questions have been considered as subjective and
* thus related to subjects’ personality [33]. However, effects of
Range by quartiles: referent first quartile. **Range by age-groups:
environmental risks are mediated by individual vulnerabilities that are
referent 4-5 years-old; subsequent: 6-8; 9-12; 13-16 years-old.
expressed on personality traits [34], and as related to the contents of
the questionnaire used (see appendix) this variable could indicate
Discussion: personality dispositions where individuals experience themselves as
Results from this epidemiological study in the general population of helpless, distrustful and misunderstood. On other hand, as
Mexico City have shown that, in terms of the odds ratios controlling commented by Benjet et al. [19], “Mexican culture is a distinct family
for the effect of socio-demographic and on-going proband’s systems organization in which families tend to be more cohesive,
psychosocial variables, the strength of the association of familial extended, interdependent, and group-oriented, a cultural value
psychiatric antecedents is moderate on either direction: backwards in sometimes called familism or familialism which has both potentially
regards of proband’s parents, OR=2.0, or downwards in regards of positive and negative consequences, the positive being that families
their children, OR=2.7. The strength of the association is similar to the provide greater social support and collective resources, and the
results obtained for specific disorders between members of two negative being that the problems of one of its members are shared by
generations in the general population of the United States [25]. all and can lead to greater caretaker burden among family members”.
However, when interaction between the two previous generations was Anyhow, this variable has both an implicit psychodynamic nature as
considered, the strength of the association was higher, crude OR=7.8, well as a socio-cultural value that should be contemplated more
and showing significant variations when controlling for the effect of carefully and in-depth.
the rest of the variables and especially for probands’ psychosocial The other variable significantly associated with the outcome
correlates. between, although not across generations, was having a poor
On the first specific question for this report, do socio-demographic perception of own’s health. This is important and closely related to
variables such as gender, age, household income and proband’s labor cultural values, as previously discussed, although not exclusive of it. If
status play a role for the development of psychopathology between and own's health is weak, caring for others is difficult, and thus feeling sick
across generations? In summary, results indicated that between G1 can be a source of stress by itself, a manifestation of the caretaker
and G2 proband’s female gender was the only socio-demographic burden, or both. Health status is one of the six indicators proposed by
variable that was inversely associated with developing Blank [35] for the operationalization of SES using multiple
psychopathology. However, being a female offspring of a G2 case was components.
observed to be associated with almost two-fold higher odds of In addition, tension over work emerged as a very interesting socio-
developing psychopathology, while female gender in G3 was inversely economic variable, significantly associated with the outcome between
associated with being a probable case. Also children’s age was G1 and G2 and across generations, but not between G2 and G3. This
positively associated with developing psychopathology. In sum, when finding suggests that there may be a moderator effect [36]. A plausible
socio-demographic variables were incorporated to the analyses only explanation resides on the family systems organization, previously
female gender and children’s age were found significantly associated mentioned and the accumulated burden of economic responsibilities
with developing psychopathology between generations. The odds ratio as inflation during the 80s heavily eroded pensions and acquisitive
indicating the strength of the association between the psychiatric power [37].
familial antecedents on the previous generation as related to the next,
were only slightly higher between parent’s, G2, and their offspring, G3, Anyway, it is important to note that SES in terms of household
when these variables were taken into account. Across generations income in the final model was not significantly associated with the
these variables seemed to have a stronger association only when there outcome; rather it was tension over work. On this, decades ago, studies
are psychiatric familial antecedents on both previous generations. suggested a complex set of intervening variables between economic life
change and symptoms in workers employed in two closing industrial
Mother´s figure is very important in familial relationships, facilities. Findings suggested that by the time a discharged worker
particularly in Latino cultures. An intergenerational study [6] have actually leaves a job, he or she may already have paid the price in
presented very interesting data on how major depressive disorder symptoms due to adaptations in self-esteem and standard of living as
(MDD) in grandmothers had an effect on grandchildren by maternal, well as to the stress of job seeking [38].
G2, chronic interpersonal stress. In the Mexican culture, most
grandmothers help their descendants in nurturing and raising Finally, does familial psychopathology risk across three generations
grandchildren, especially if both parents have to work, or when their is significantly influenced by ongoing psychosocial variables reported
offspring are single parents. by probands? Morbid risk measures presented in terms of prevalence
ratios showed that between G1 and G2 the morbid risk was 1.6 (95%
On the second question, does proband’s psychosocial variables play CI: 1.3, 2.1), between G2 and G3 was 2.1 (95%CI: 1.6, 2.8) and notably
a role for the development of probable psychopathology between and increased across generations to become G1= 2.7 (95% CI: 1.4, 5.0), G2
across generations? The results from this study have shown that = 2.9 (95% CI: 1.3, 6.6) and for G1 and G2 = 4,6 (95% CI: 2.3, 9.4). The
between and across generations the most consistent variable associated increased morbid risk on G1 alone may be that, as already mentioned,
with the outcome is the perception of less support from family (not grandparents are expected to help their descendants in nurturing and
living at the same household). raising grandchildren especially if both parents have to work, or when
their offspring are single parents, so that the effect on grandchildren

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ISSN:JCALB, an open access journal JCALB, an open access journal
Citation: Caraveo JJ (2014) Familial Risk Across Three Generations and Psychosocial Correlates for Developing Psychopathology in a
Changing World. J Child Adolesc Behav 2: 131. doi:10.4172/jcalb.1000131

Page 7 of 8

may be the result of interpersonal stress between parental and important limitations, rather than a poor substitute of personal
grandparental figures or directly between grandparents and interviews [25].
grandchildren [6].
Information about children and adolescents was obtained from the
Among the general population the PAR% of any psychiatric parent and not by direct interviews so that reliability and validity could
disorder between generations was practically the same, 20.8% and be an issue. On this, it has been recommended that all epidemiological
17.1%, respectively, across generations. When there were psychiatric information should be considered as “informant’s especific” [40, 41],
antecedents on both G1 and G2, the PAR% was practically twofold, although on a long-term follow-up study Hofstra et al. [42] found a
36.0%, as compared to just having psychopathological antecedents on considerable stability on parents’ reports in a period that extended for
either G1 or G2, thus suggesting a possible genetic component. 14 years.
The PAR% of perceiving less support by non-nuclear family of G2 Although the study was only based on adult probands information
as related to G1 was between 11.4% and 26.2%, varied considerably it has the advantage of minimal bias as related to help-seeking,
and increased in relation to G3, from 4.3% to 64%, maybe indicating reference and use of services.
the urgency of helping demand that the economic crisis imposed.
Notwithstanding these limitations, our results have shown that
When interaction across generations was considered the PAR% of
among the Mexican population psycho-social variables, mainly stress
perceiving less support by non-nuclear family was between 4.2% and
over work and an adverse perception of family support, are associated
28.3%, thus suggesting that most of the effect was already expressed as
with developing psychopathology across generations. The first is a
related to G1.
socio-economical factor and the second a psychodynamic factor, both
Among the general population the PAR% of proband’s tension over possibly interacting across time with psychiatric familial risk for the
work as related to G1 was between 15.4% and 34.4%, and from 2.7% to outcome. It is our hope that these results may help explain and
17.3% as related to G3, and when interaction across generations was understand the high complexity of mental health problems in
considered the PAR% extended between 1.8% and 44%. These results populations exposed to heavy economical changes and the need for
suggest that most of the burden and worries pending on the adult developing policies and programs in accordance to human needs.
population may have been already present at the time of the study and
related to the parents rather than to the offspring, and the economical Acknowledgments
crisis increased it. The relevance of tension over work can be better
understood by considering that the contribution of this variable to the This study was funded by The National Council of Science and
mental health status of children and adolescents exceeded the Technology (CONACYT), award 2077-H9302. Dr. Fernando A.
population PAR% of having psychopathological antecedents on G1and Wagner offered valuable suggestions to a later version of this
G2. manuscript. To the Editor for the invitation to prepare this manuscript
and to Reviewers for their useful comments.
Consistent with our observation, on the impact of SES on child
development, McLoyd’s [17] posited “that these problems do not
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Citation: Caraveo JJ (2014) Familial Risk Across Three Generations and Psychosocial Correlates for Developing Psychopathology in a
Changing World. J Child Adolesc Behav 2: 131. doi:10.4172/jcalb.1000131

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