Article

Naturalistic Follow-up of Youths Treated for Pediatric Anxiety Disorders

JAMA Psychiatry (Impact Factor: 12.01). 01/2014; 71(3). DOI: 10.1001/jamapsychiatry.2013.4186
Source: PubMed

ABSTRACT

Importance
Pediatric anxiety disorders are highly prevalent and impairing and are considered gateway disorders in that they predict adult psychiatric problems. Although they can be effectively treated in the short term, data are limited on the long-term outcomes in treated children and adolescents, particularly those treated with medication.Objective
To determine whether acute clinical improvement and treatment type (ie, cognitive behavioral therapy, medication, or their combination) predicted remission of anxiety and improvement in global functioning at a mean of 6 years after randomization and to examine predictors of outcomes at follow-up.Design, Setting, and Participants
This naturalistic follow-up study, as part of the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), was conducted at 6 academic sites in the United States and included 288 youths (age range, 11-26 years; mean age, 17 years). Youths were randomized to 1 of 4 interventions (cognitive behavioral therapy, medication, combination, or pill placebo) in the Child/Adolescent Anxiety Multimodal Study (CAMS) and were evaluated a mean of 6 years after randomization. Participants in this study constituted 59.0% of the original CAMS sample.Exposures
Participants were assessed by independent evaluators using a semistructured diagnostic interview to determine the presence of anxiety disorders, the severity of anxiety, and global functioning. Participants and their parents completed questionnaires about mental health symptoms, family functioning, life events, and mental health service use.Main Outcomes and Measures
Remission, defined as the absence of all study entry anxiety disorders.Results
Almost half of the sample (46.5%) were in remission a mean of 6 years after randomization. Responders to acute treatment were significantly more likely to be in remission (odds ratio, 1.83; 95% CI, 1.08-3.09) and had less severe anxiety symptoms and higher functioning; the assigned treatment arm was unrelated to outcomes. Several predictors of remission and functioning were identified.Conclusions and Relevance
Youths rated as responders during the acute treatment phase of CAMS were more likely to be in remission a mean of 6 years after randomization, although the effect size was small. Relapse occurred in almost half (48%) of acute responders, suggesting the need for more intensive or continued treatment for a sizable proportion of youths with anxiety disorders.Trial Registration
clinicaltrials.gov Identifier: NCT00052078

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Available from: Courtney Pierce Keeton, Aug 26, 2014
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    • "For example, higher pretreatment severity (of OCD) and higher family dysfunction predicted poorer outcomes at 12- and 18-month follow-up (Barrett, Farrell, Dadds, & Boulter, 2005). Anxiety severity and family functioning (e.g., clear family rules; high-quality family interactions; trust) was also predictive in a 4-to 10-year follow-up of 288 participants treated for anxiety between the ages of 7 and 17: Youth with lower pretreatment anxiety severity and better family functioning were more likely to maintain gains over time (be in remission; defined as loss of all study entry anxiety disorder diagnoses) an average of 6 years later (Ginsburg et al., 2014). With regard to OCD and anxiety in youth, directly targeting these variables may enhance the maintenance of gains over time. "
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    • "Our study is unique because we were able to follow untreated anxious children as compared to treated children over an average of 8 years in a naturalistic fashion utilizing existing data and infrastructure. Our findings, that show approximately 50% of anxious children remit over time, are consistent with previous LTFU findings, which followed only treated children (Ginsburg et al. 2014; James et al. 2013). Contrary to previous belief, CBT did not appear to enhance remission rates relative to our non-CBT control condition. "
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