Clinical Predictors of Response to Cognitive-Behavioral Therapy in Pediatric Anxiety Disorders: The Genes for Treatment (GxT) Study.
Clinical Predictors of Response to Cognitive-Behavioral Therapy in Pediatric Anxiety Disorders: The Genes for Treatment (GxT) Study.
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DOI：
10.1016/j.jaac.2015.03.018
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发表时间：
2015-06
影响因子：
13.3
通讯作者：
Eley, Thalia C.
中科院分区：
文献类型：
--
作者：
Hudson, Jennifer L.;Keers, Robert;Roberts, Susanna;Coleman, Jonathan R. I.;Breen, Gerome;Arendt, Kristian;Boegels, Susan;Cooper, Peter;Creswell, Cathy;Hartman, Catharina;Heiervang, Einar R.;Hoetzel, Katrin;In-Albon, Tina;Lavallee, Kristen;Lyne-Ham, Heidi J.;Marin, Carla E.;McKinnon, Anna;Meiser-Stedman, Richard;Morris, Talia;Nauta, Maaike;Rapee, Ronald M.;Schneider, Silvia;Schneider, Sophie C.;Silverman, Wendy K.;Thastum, Mikael;Thirlwall, Kerstin;Waite, Polly;Wergeland, Gro Janne;Lester, Kathryn J.;Eley, Thalia C.
基因治疗研究是一项国际多点合作，探索遗传、人口统计学和临床预测因素在儿童焦虑症认知行为治疗(CBT)中的作用。目前的文章是该研究的第一篇，研究了CBT反应的人口学和临床预测因素。我们假设孩子的性别、焦虑症的类型、最初的严重程度和合并症以及父母的精神病理将显著预测结果。对1,519名被诊断为主要焦虑症的5至18岁儿童进行了11个地点的CBT。结果被定义为在每个时间点(治疗后、3个月、6个月和/或12个月随访)的反应(诊断严重程度的变化)和缓解(没有主要诊断)，并使用线性和Logistic混合模型进行分析。使用来自治疗后和后续评估的数据进行了单独的分析，以探索这些时间点的预测因素的相对重要性。社交焦虑症(SOAD)患者的预后显著低于广泛性焦虑症(GAD)患者(反应更差，缓解率更低)。虽然有特殊恐惧症(SP)的患者在治疗后的结果也比GAD患者差，但这些差异在随访中没有保持。在治疗后和随访中，情绪障碍和外在性障碍的并存显著预示着较差的结果，而自我报告的父母精神病理学对治疗后的结果影响不大，但在随访时显著预测反应(尽管不是缓解)。SOAD、非焦虑性共病和父母的精神病理与CBT后较差的预后相关。这一结果突显了加强对结局较差的风险儿童的治疗的必要性。
The Genes for Treatment study is an international, multisite collaboration exploring the role of genetic, demographic, and clinical predictors in response to cognitive-behavioral therapy (CBT) in pediatric anxiety disorders. The current article, the first from the study, examined demographic and clinical predictors of response to CBT. We hypothesized that the child’s gender, type of anxiety disorder, initial severity and comorbidity, and parents’ psychopathology would significantly predict outcome. A sample of 1,519 children 5 to 18 years of age with a primary anxiety diagnosis received CBT across 11 sites. Outcome was defined as response (change in diagnostic severity) and remission (absence of the primary diagnosis) at each time point (posttreatment, 3-, 6-, and/or 12-month follow-up) and analyzed using linear and logistic mixed models. Separate analyses were conducted using data from posttreatment and follow-up assessments to explore the relative importance of predictors at these time points. Individuals with social anxiety disorder (SoAD) had significantly poorer outcomes (poorer response and lower rates of remission) than those with generalized anxiety disorder (GAD). Although individuals with specific phobia (SP) also had poorer outcomes than those with GAD at posttreatment, these differences were not maintained at follow-up. Both comorbid mood and externalizing disorders significantly predicted poorer outcomes at posttreatment and follow-up, whereas self-reported parental psychopathology had little effect on posttreatment outcomes but significantly predicted response (although not remission) at follow-up. SoAD, nonanxiety comorbidity, and parental psychopathology were associated with poorer outcomes after CBT. The results highlight the need for enhanced treatments for children at risk for poorer outcomes.
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DOI：
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发表时间：
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影响因子：
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作者：
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