Oct 15, 2025
Systematic Review Protocol
- Dr. Timur Syunyakov1,
- Oksana Chigareva2,
- Dr. Yekaterina Lyan1,3,
- Botirbek Vosikov4,
- Roza Userbayeva4,
- Shahina Atadjanova4,
- Kamilla Kholmuradova5
- 1Republican Specialized Scientific-Practical Medical Center of Mental Health, Tashkent, Uzbekistan;
- 2REAVIZ University, Samara, Russian Federation.;
- 3Central Asian University, Tashkent, Uzbekistan.;
- 4Tashkent State Medical University, Tashkent, Uzbekistan.;
- 5Lomonosov Moscow State University, Moscow, Russian Federation.
- Impact of social and family-related stressors on metnal health of children under 13 years
Protocol Citation: Dr. Timur Syunyakov, Oksana Chigareva, Dr. Yekaterina Lyan, Botirbek Vosikov, Roza Userbayeva, Shahina Atadjanova, Kamilla Kholmuradova 2025. Systematic Review Protocol . protocols.io https://dx.doi.org/10.17504/protocols.io.x54v95kmml3e/v1
License: This is an open access protocol 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
Protocol status: In development
We are still developing and optimizing this protocol
Created: September 25, 2025
Last Modified: October 15, 2025
Protocol Integer ID: 228146
Keywords: mental health, child psychiatry, anxiety disorders, social stressors, family conflict, bullying, pediatrics, other mental disorders in preschool, family stressors on the development, developing mental disorder, family stressor, association with children, such as school bullying, school bullying, mental health, mental health problem, vulnerable to external stressor, family issue, other mental disorder, healthy development, including parental conflict, mental disorder, preschool, external stressor, parental conflict, powerful stressor, foundation for healthy development, anxiety, family instability, children, aged children, social factor
Abstract
Children's mental health is a fundamental component of overall well-being and lays the foundation for healthy development into adulthood. Children, especially those under 13, are highly vulnerable to external stressors. Social factors, such as school bullying, and family issues, including parental conflicts, divorce, or family instability, are powerful stressors that can significantly increase the risk of developing mental disorders. Despite a growing body of research in this area, there is a need to systematize the existing data to obtain a comprehensive picture of the impact of specific social and family stressors on the development of anxiety and other mental disorders in preschool and elementary school-aged children. This systematic review aims to summarize and analyze the results of original research to identify key risk factors and assess the strength of their association with children's mental health problems.
Troubleshooting
Before start
1. Study Types: Cohort studies, case-control studies.
2. Participant Age: Up to 13 years inclusive (under 14).
3. Exposure: The study evaluates the impact of social, family, or school-related stressors.
4. Outcome: The primary outcome is a diagnosed mental disorder according to international classifications (DSM, ICD).
Exclusion Criteria:
1. Reviews, meta-analyses, letters to the editor, case reports.
2. Studies examining the general impact of somatic diseases on mental health.
3. Studies examining any other psychiatric disorder aside from anxiety disorders in children.
4. Studies focused on children aged 13 and older.
5. Studies focused exclusively on Autism Spectrum Disorders (ASD) as the primary outcome.
Review Title
Impact of social and family-related stressors on the onset of anxiety disorders in children under 14 years.
Protocol Registration and Keywords
Registration: This protocol will be registered in the Protocols.io - international Open Science Framework (OSF) Registry.
Keywords: mental health, child psychiatry, anxiety disorders, social stressors, family conflict, bullying, pediatrics.
Administrative Information
Contact Person: Dr. Timur Syunyakov.
Contact Email and Affiliation: [email protected], Republican Specialized Scientific and Practical Medical Center for Mental Health, Tashkent, Uzbekistan.
Team Affiliations: Oksana Chigareva - REAVIZ University, Samara, Russian Federation.
Dr. Yekaterina Lyan - Republican Specialized Scientific-Practical Medical Center of Mental Health, Tashkent, Uzbekistan; Central Asian University, Tashkent, Uzbekistan.
Botirbek Vosikov - Tashkent State Medical University, Tashkent, Uzbekistan; Republican Specialized Scientific-Practical Medical Center of Mental Health, Tashkent, Uzbekistan.
Roza Userbayeva - Tashkent State Medical University, Tashkent, Uzbekistan.
Shahina Atadjanova - Tashkent State Medical University, Tashkent, Uzbekistan.
Kamilla Kholmuradova - Lomonosov Moscow State University, Moscow, Russian Federation.
Funding/Sponsors: There is no funding for this review.
Conflict of Interest: The authors declare no conflict of interest.
Project Dates:
Start Date: 20.01.2025
Anticipated Completion Date: 20.12.2025
Current Stage of Review: The preliminary search and the screening of titles and abstracts have been completed.
Review Type
Systematic review. If a sufficient number of homogeneous studies are available, a meta-analysis will be conducted.
Field of Study
Biomedicine, Psychiatry, Pediatrics.
Description and Rationale
Children's mental health is a fundamental component of overall well-being and lays the foundation for healthy development into adulthood. Children, especially those under 14, are highly vulnerable to external stressors. Social factors, such as school bullying, and family issues, including parental conflicts, divorce, or family instability, are powerful stressors that can significantly increase the risk of developing mental disorders [1, 2, 3]. Despite a growing body of research in this area, there is a need to systematize the existing data to obtain a comprehensive picture of the impact of specific social and family stressors on the development of anxiety and other mental disorders in preschool and elementary school-aged children[4, 5]. This systematic review aims to summarize and analyze the results of original research to identify key risk factors and assess the strength of their association with children's mental health problems.
References:
1. Copeland WE, Wolke D, Angold A, Costello EJ. Adult Psychiatric Outcomes of Bullying and Being Bullied by Peers in Childhood and Adolescence. JAMA Psychiatry. 2013;70(4):419–426. doi:10.1001/jamapsychiatry.2013.504
2. Singham T, Viding E, Schoeler T, et al. Concurrent and Longitudinal Contribution of Exposure to Bullying in Childhood to Mental Health: The Role of Vulnerability and Resilience. JAMA Psychiatry. 2017;74(11):1112–1119. doi:10.1001/jamapsychiatry.2017.2678
3. Ariani, T. A., Putri, A. R., Firdausi, F. A., & Aini, N. (2025). Global prevalence and psychological impact of bullying among children and adolescents: a meta-analysis. Journal of Affective Disorders, 385, 119446.
4. Smith, K. E., & Pollak, S. D. (2020). Early life stress and development: potential mechanisms for adverse outcomes. Journal of neurodevelopmental disorders, 12(1), 34.
5. Ran, G., Niu, X., Zhang, Q., Li, S., Liu, J., Chen, X., & Wu, J. (2021). The association between interparental conflict and youth anxiety: A three-level meta-analysis. Journal of Youth and Adolescence, 50(4), 599-612.
Review Objectives / Research Question (PICO)
The main objective of this review is to systematically evaluate and synthesize available scientific data on the relationship between social and family stressors and the development of anxiety disorders in children under 14 years of age.
P (Population): Children under 14 years of age.
E (Exposure): Social (e.g., bullying, peer problems) or family-related (e.g., divorce, parental conflict) stressors.
C (Comparison): Children not exposed to the specified stressors, or with a lower level of exposure.
O (Outcome): Diagnosed anxiety mental disorders. Secondary outcomes are not considered.
Methods
Eligibility Criteria
Inclusion Criteria:
Study Types: Cohort studies, case-control studies.
Participant Age: Up to 13 years inclusive (under 14).
Exposure: The study evaluates the impact of social, family, or school-related stressors.
Outcome: The primary outcome is a diagnosed mental disorder according to international classifications (DSM, ICD).
Exclusion Criteria:
Reviews, meta-analyses, letters to the editor, case reports.
Studies examining the general impact of somatic diseases on mental health.
Studies examining any other psychiatric disorder aside from anxiety disorders in children.
Studies focused on children aged 14 and older.
Studies focused exclusively on Autism Spectrum Disorders (ASD) as the primary outcome.
Information Sources and Search Strategy
The search will be conducted in the following electronic databases: PubMed, Scopus, Web of Science. No restrictions on publication date or language will be applied.
Search Strategies:
PubMed: (TI=(("anxiety disorder*" OR "child anxiety" OR "pediatric anxiety" OR "generalized anxiety disorder" OR "GAD" OR "social anxiety disorder" OR "SAD" OR "separation anxiety disorder" OR "panic disorder" OR "panic attack*" OR "specific phobia*" OR "phobia*" OR "fear disorder*" OR "fearfulness") AND ("bullying" OR "peer victimization" OR "school bullying" OR "cyberbullying" OR "peer harassment" OR "peer aggression" OR "social bullying" OR "verbal bullying" OR "physical bullying" OR "relational bullying" OR "psychological bullying" OR "online harassment" OR "digital bullying" OR "cyber harassment" OR "peer abuse" OR "mobbing" OR "youth violence" OR "student bullying" OR "workplace bullying" OR "bully victimization" OR "family separation" OR "parental separation" OR "family conflict" OR "parental conflict" OR "divorce" OR "broken family" OR "disrupted family" OR "family breakup" OR "disintegrated family" OR "marital conflict" OR "parental alienation" OR "interparental conflict" OR "domestic discord" OR "household conflict" OR "family dysfunction" OR "disrupted home environment" OR "childhood adversity" OR "family instability" OR "parental neglect")) OR (AB=(("anxiety disorder*" OR "child anxiety" OR "pediatric anxiety" OR "generalized anxiety disorder" OR "GAD" OR "social anxiety disorder" OR "SAD" OR "separation anxiety disorder" OR "panic disorder" OR "panic attack*" OR "specific phobia*" OR "phobia*" OR "fear disorder*" OR "fearfulness") AND ("bullying" OR "peer victimization" OR "school bullying" OR "cyberbullying" OR "peer harassment" OR "peer aggression" OR "social bullying" OR "verbal bullying" OR "physical bullying" OR "relational bullying" OR "psychological bullying" OR "online harassment" OR "digital bullying" OR "cyber harassment" OR "peer abuse" OR "mobbing" OR "youth violence" OR "student bullying" OR "workplace bullying" OR "bully victimization" OR "family separation" OR "parental separation" OR "family conflict" OR "parental conflict" OR "divorce" OR "broken family" OR "disrupted family" OR "family breakup" OR "disintegrated family" OR "marital conflict" OR "parental alienation" OR "interparental conflict" OR "domestic discord" OR "household conflict" OR "family dysfunction" OR "disrupted home environment" OR "childhood adversity" OR "family instability" OR "parental neglect")))
Scopus: TITLE-ABS-KEY ( "anxiety disorder*" OR "child anxiety" OR "pediatric anxiety" OR "generalized anxiety disorder" OR "GAD" OR "social anxiety disorder" OR "SAD" OR "separation anxiety disorder" OR "panic disorder" OR "panic attack*" OR "specific phobia*" OR "phobia*" OR "fear disorder*" OR "fearfulness" ) AND ( TITLE-ABS-KEY ( "bullying" OR "peer victimization" OR "school bullying" OR "cyberbullying" OR "peer harassment" OR "peer aggression" OR "social bullying" OR "verbal bullying" OR "physical bullying" OR "relational bullying" OR "psychological bullying" OR "online harassment" OR "digital bullying" OR "cyber harassment" OR "peer abuse" OR "mobbing" OR "youth violence" OR "student bullying" OR "workplace bullying" OR "bully victimization" ) OR TITLE-ABS-KEY ( "family separation" OR "parental separation" OR "family conflict" OR "parental conflict" OR "divorce" OR "broken family" OR "disrupted family" OR "family breakup" OR "disintegrated family" OR "marital conflict" OR "parental alienation" OR "interparental conflict" OR "domestic discord" OR "household conflict" OR "family dysfunction" OR "disrupted home environment" OR "childhood adversity" OR "family instability" OR "parental neglect"))
Web of Science: TS=(("anxiety disorder*" OR "child anxiety" OR "pediatric anxiety" OR "generalized anxiety disorder" OR "GAD" OR "social anxiety disorder" OR "SAD" OR "separation anxiety disorder" OR "panic disorder" OR "panic attack*" OR "specific phobia*" OR "phobia*" OR "fear disorder*" OR "fearfulness") AND ("bullying" OR "peer victimization" OR "school bullying" OR "cyberbullying" OR "peer harassment" OR "peer aggression" OR "social bullying" OR "verbal bullying" OR "physical bullying" OR "relational bullying" OR "psychological bullying" OR "online harassment" OR "digital bullying" OR "cyber harassment" OR "peer abuse" OR "mobbing" OR "youth violence" OR "student bullying" OR "workplace bullying" OR "bully victimization" OR "family separation" OR "parental separation" OR "family conflict" OR "parental conflict" OR "divorce" OR "broken family" OR "disrupted family" OR "family breakup" OR "disintegrated family" OR "marital conflict" OR "parental alienation" OR "interparental conflict" OR "domestic discord" OR "household conflict" OR "family dysfunction" OR "disrupted home environment" OR "childhood adversity" OR "family instability" OR "parental neglect"))
Data Extraction
Two reviewers will independently extract data from the included studies using a standardized form, including: publication information, study and population characteristics, description of exposure and outcome, and main results.
Risk of Bias Assessment
The quality of the studies will be assessed by two independent reviewers using the Newcastle-Ottawa Scale (NOS) for observational studies and the Cochrane Risk of Bias tool (RoB 2) for RCTs.
Data Synthesis
The results will be summarized in a narrative synthesis. Subgroup analyses are planned based on: the type of stressor (social/family), gender, and age group (preschool/elementary school), if sufficient data are available. If there is sufficient homogeneity among the studies, a meta-analysis will be considered.
Dissemination Plan
The results of the review are planned to be published in a peer-reviewed scientific journal and presented at relevant scientific conferences.
Project Team
Dr. Timur Syunyakov (Owner) - Republican Specialized Scientific-Practical Medical Center of Mental Health, Tashkent, Uzbekistan.
Oksana Chigareva - REAVIZ University, Samara, Russian Federation.
Dr. Yekaterina Lyan - Republican Specialized Scientific-Practical Medical Center of Mental Health, Tashkent, Uzbekistan; Central Asian University, Tashkent, Uzbekistan.
Botirbek Vosikov - Tashkent State Medical University, Tashkent, Uzbekistan; Republican Specialized Scientific-Practical Medical Center of Mental Health, Tashkent, Uzbekistan.
Roza Userbayeva - Tashkent State Medical University, Tashkent, Uzbekistan.
Shahina Atadjanova - Tashkent State Medical University, Tashkent, Uzbekistan.
Kamilla Kholmuradova - Lomonosov Moscow State University, Tashkent Branch, 4th-year student, Faculty of Psychology.
Protocol references
1. Copeland WE, Wolke D, Angold A, Costello EJ. Adult Psychiatric Outcomes of Bullying and Being Bullied by Peers in Childhood and Adolescence. JAMA Psychiatry. 2013;70(4):419–426. doi:10.1001/jamapsychiatry.2013.504
2. Singham T, Viding E, Schoeler T, et al. Concurrent and Longitudinal Contribution of Exposure to Bullying in Childhood to Mental Health: The Role of Vulnerability and Resilience. JAMA Psychiatry. 2017;74(11):1112–1119. doi:10.1001/jamapsychiatry.2017.2678
3. Ariani, T. A., Putri, A. R., Firdausi, F. A., & Aini, N. (2025). Global prevalence and psychological impact of bullying among children and adolescents: a meta-analysis. Journal of Affective Disorders, 385, 119446.
4. Smith, K. E., & Pollak, S. D. (2020). Early life stress and development: potential mechanisms for adverse outcomes. Journal of neurodevelopmental disorders, 12(1), 34.
5. Ran, G., Niu, X., Zhang, Q., Li, S., Liu, J., Chen, X., & Wu, J. (2021). The association between interparental conflict and youth anxiety: A three-level meta-analysis. Journal of Youth and Adolescence, 50(4), 599-612.