Identifying Risk and Protective Factors Impacting the Clinical Outcomes of Subthreshold Anxiety in Early Adolescents: Insights From the ABCD Study

Background: Subthreshold anxiety (STA) is a significant risk factor for developing anxiety disorder (AX), particularly in adolescence. Understanding the risk and protective factors of the development of STA in early life is essential for early prevention and intervention efforts. However, research on this topic is scarce. Methods: We examined the data of 11,876 early adolescents from the Adolescent Brain and Cognitive Development (ABCD) Study to explore the factors influencing the development of STA between ages 9 and 13. The outcomes included developing AX, persistent STA, and remission from STA. Using the Child Behavior Checklist (CBCL), we identified 786 participants with STA. To predict STA transitions, we analyzed 31 diathesis‐stress‐related variables covering demographics, mental and physical health, and environmental factors, employing logistic regression. Results: Compared to baseline healthy controls (HCs), adolescents with STA showed an odds ratio (OR) of 6.9 for converting to AX. The pivotal risk factors for progression from STA to AX were lack of perseverance and area deprivation, with females being more likely to maintain STA. Protective factors for a favorable prognosis of STA included the absence of traumatic history, lack of premeditation, increased physical activity, and positive school environment. Conclusions: Healing traumatic experiences, increased physical activity, and enhancing school and family environments could help prevent adverse outcomes. By targeting these modifiable factors, adolescents at high risk can be identified and provided with interventions early in life.