Brief Pediatrics-Based Intervention Can Curb Anxiety, Depression

April 25, 2017

By Marilynn Larkin

NEW YORK—A brief, pediatrics-based behavioral intervention for anxiety and depression is associated with more benefits than referring children to an outpatient mental health setting, researchers say.

Dr. Robin Weersing of San Diego State University in California told Reuters Health, “Anxiety and depression are very widespread and tremendously impairing in childhood and adolescence, but the good news is that these problems are treatable, and it doesn't need to take months and months of intervention to see big changes in children's lives.”

“A simple, brief behavioral intervention – eight to 12 sessions, 45-minutes each - can have significant clinical effects,” she said by email, “and pediatrics is a very promising setting for addressing (children’s) mental health needs.”

As reported online April 19 in JAMA Psychiatry, from 2010 to 2014 Dr. Weersing and colleagues randomly assigned 185 young people – mean age 11, 58% female, 78% white – from pediatric clinics in San Diego and Pittsburgh, Pennsylvania to brief behavioral therapy (BBT) or assisted referral care (ARC).

Participants met DSM-IV criteria for diagnoses of separation anxiety disorder, generalized anxiety disorder, social phobia, major depression, dysthymic disorder and/or minor depression, and had lived for at least six months with a parent or legal guardian.

The BBT sessions were conducted by trained Master’s-level clinicians and included gradual engagement in avoided activities in addition to relaxation to manage somatic symptoms and problem-solving skills to help with stress management.

ARC families were given personalized referrals to mental health care from Master’s-level coordinators and check-in phone calls to support compliance.

Compared with those in the ARC group and using standard measurement tools, at week 16, those in the BBT group had significantly higher rates of clinical improvement (56.8% versus 28.2%), greater reductions in symptoms, and better functioning.

Time was also a factor, with BBT group participants improving faster than those in the ARC group, an effect the authors suggest is “largely driven by the superior effect of BBT on anxiety.”

Ethnicity significantly influenced response to therapy (odds ratio, 19.94), with Hispanic participants having a high response to BBT and little response to ARC (76.5% versus 7.1%; P<0.001).

Ethnicity also significantly influenced changes in functioning. Hispanic BBT participants improved by a mean of 15.5 points on the Children's Global Adjustment Scale, shifting two qualitative functioning categories. By contrast, the mean CGAS score change for Hispanic ARC participants was less than one point.

One in 10 children “will suffer a significant bout of anxiety or depression,” Dr. Weersing said, “and that's way too many . . . for our current mental health system to handle.”

“However, nine out of 10 kids already have a pediatrician,” she observed, “and pediatrics is a trusted physical health care setting already.”

She added, “Building practical behavioral interventions, involving parents and working in trusted health care settings like pediatrics, we may be able to address ethnic disparities in care that have been so prominent in the literature and have positive outcomes for a wide range of diverse families.”

Editorialist Dr. John Walkup, Program Co-Director at the New York-Presbyterian Youth Anxiety Center and Weill Cornell Medicine in New York City, told Reuters Health, “Bringing mental health care to primary care has the potential to meet the enormous mental health burden in the U.S. and the world.”

“We have the treatment tools,” he said by email. “Much more will need to be done to develop the strategies to get treatment delivered broadly, efficient and effectively.”


JAMA Psychiatry 2017.

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