A Longitudinal Examination of the Relationship between Childhood Emotional Abuse and Anxiety among Youth: Distress Tolerance as a Mediating and Moderating Factor

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Background: Anxiety is the most common psychological problem experienced by youth. A number of factors are associated with the emergence of anxiety, including individual and environmental factors. Two such factors include childhood emotional abuse (CEA) and low distress tolerance (DT). The current study aimed to understand how more severe CEA and lower DT impacted anxiety symptoms among community youth. Specifically, we examined low DT both as a moderator and mediator in the relationship between CEA and anxiety. Methods: Participants were two cohorts of community youth. Cohort 1 included 244 youth (54% male, 50% White, 35% Black, 3% Hispanic, 11% mixed/other) with a mean baseline age of 12.01 years (SD = 0.82) assessed annually over five years. Cohort 2 included 109 youth (60% male, 11% White, 79% Black, 10% mixed/other) with a mean baseline age of 10.87 years (SD = 1.28) assessed annually over three years. Measures included the Revised Child Anxiety and Depression Scale, Childhood Trauma Questionnaire, and Behavioral Indicator of Resiliency to Distress. Results: In cohort 1, more severe CEA was associated with higher anxiety at baseline and with sharper decreases in anxiety over time. Lower DT was associated with higher anxiety at baseline, but did not predict changes in anxiety over time. Distress tolerance significantly moderated the relationship between CEA and anxiety, such that youth with both low DT and more severe CEA had the highest anxiety across all five assessments. Results using data from cohort 2 were not significant. Conclusions: These findings suggest lower DT amplifies the relationship between CEA and anxiety, such that youth with lower DT, who have been abused, are less likely to experience normalization in anxiety symptoms over time compared to youth with higher DT. These findings are in line with diathesis-stress models common to developmental psychopathology.