# Early Childhood Anxiety and Maternal Factors: Associations with State and Trait Anxiety in a Greek Cohort of Preschoolers

## TL;DR

This study explores how maternal factors like anxiety and education are linked to preschoolers' anxiety in Greece, finding that maternal mental health influences both state and trait anxiety in children.

## Contribution

The study identifies distinct associations between maternal psychological factors and children's state versus trait anxiety dimensions.

## Key findings

- Maternal anxiety is positively linked to children's state anxiety.
- Maternal depressive symptoms show the strongest association with children's trait anxiety.
- The models explain only a modest portion of the variance in child anxiety.

## Abstract

Background/Objective: Anxiety symptoms in preschool children represent early indicators of potential mental health vulnerabilities. Maternal psychological, sociodemographic, lifestyle and dietary factors may be associated with child emotional development; however, evidence regarding their independent contributions to distinct dimensions of child anxiety (trait vs. state) remains limited. This study aimed to examine maternal factors associated with preschool children’s trait and state anxiety. Methods: In this cross-sectional study conducted in Greece, 200 preschool-aged children and their mothers were assessed. Maternal demographic, socioeconomic, anthropometric, lifestyle, dietary, and psychosocial characteristics were evaluated using validated instruments, including the Mediterranean Diet Score (MedDietScore), Beck Depression Inventory–II (BDI-II), and the State–Trait Anxiety Inventory short form (STAI-6). Children’s trait and state anxiety were assessed using the State–Trait Anxiety Inventory for Children (STAI-CH). Bivariate analyses were conducted, followed by separate multivariable linear regression models for trait and state anxiety, with covariate selection guided by a directed acyclic graph (DAG). Results: Maternal anxiety was positively associated with children’s state anxiety (B = 1.508, SE = 0.566, β = 0.196, t = 2.666, p = 0.008; 95% CI [0.43, 2.66]). Higher maternal educational attainment demonstrated a weak positive association with child state anxiety (B = 1.061, SE = 0.509, β = 0.145, t = 2.086, p = 0.038; 95% CI [0.08, 2.09]), which may reflect greater awareness or reporting of child symptoms by more-educated mothers or other unmeasured factors. For trait anxiety, maternal depressive symptomatology exhibited the strongest association (B = 3.578, SE = 0.918, β = 0.276, t = 3.897, p < 0.001; 95% CI [1.77, 5.39]), while maternal anxiety was also independently associated with higher trait anxiety (B = 2.088, SE = 0.744, β = 0.194, t = 2.807, p = 0.006; 95% CI [0.62, 3.56]). The models explained a modest proportion of variance (R2 < 0.15), indicating that most variation in child anxiety does not seem to be fully explained by the specific measured maternal factors. Conclusions: Maternal psychological distress was modestly associated with preschool children’s state and trait anxiety, exhibiting differential patterns across anxiety dimensions. These findings should be interpreted as correlational, with unmeasured contributors such as paternal mental health, family functioning, genetics, and school/peer influences likely playing important roles. Early screening and interventions addressing maternal mental health may support children’s emotional well-being, but further multi-informant and longitudinal research is needed to clarify temporal and causal pathways.