Effect of Comorbidity on Treatment of Anxious Children and Adolescents: Results From a Large, Combined Sample
Effect of Comorbidity on Treatment of Anxious Children and Adolescents: Results From a Large, Combined Sample
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DOI：
10.1016/j.jaac.2012.10.002
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发表时间：
2013-01-01
影响因子：
13.3
通讯作者：
Schniering, Carolyn A.
中科院分区：
文献类型：
--
作者：
Rapee, Ronald M.;Lyneham, Heidi J.;Schniering, Carolyn A.
目的：本研究的目的是评估共病障碍对焦虑青少年认知行为治疗的改变程度和终点的影响。方法：从同一诊所不同样本中收集750名6~18岁儿童的资料。所有儿童都患有原发焦虑症，并参加了基于手动的、10个疗程的认知行为治疗计划。根据诊断状态和持续的症状测量来确定结果。分析比较四组结果：无共病组、共病焦虑组、共病外化障碍组、共病情绪障碍组。所有分析均为意向处理分析。结果：在治疗和随访结束时，患有抑郁症的儿童最不可能摆脱最初的焦虑症诊断。根据儿童和产妇的报告，所有组的焦虑症状随着时间的推移都有类似的下降，但患有共病情绪障碍的儿童在所有时间点的得分都明显最高。检查焦虑治疗对共病障碍的影响表明，随着时间的推移，共病情绪障碍显著减少，但外化障碍并没有显著减少。结论：共病障碍的存在似乎不影响认知行为疗法治疗儿童焦虑症的反应速度或程度。然而，共病对治疗终点有显著影响。患有非焦虑症的儿童，特别是合并情绪障碍的儿童，一开始表现出更严重的症状，治疗后仍更严重。从积极的方面来看，焦虑症的治疗似乎可以减少共病的情绪障碍，尽管它对共病的外在障碍影响较小。J.Am阿卡德。青春期儿童。《精神病学》；2012；52(1)：47-56。
Objective: The purpose of the present study was to evaluate the influence of comorbid disorders on the degree of change and the endpoint of cognitive-behavioral treatment in anxious young people. Method: Data on 750 children 6 to 18 years old were compiled from different samples within one clinic. All children had a primary anxiety disorder and were engaged in a manual-based, 10-session, cognitive-behavioral treatment program. Outcome was determined according to diagnostic status and continuous symptom measurements. Analyses compared results among four groups: no comorbidity, comorbid anxiety disorders, comorbid externalizing disorders, comorbid mood disorders. All analyses were intent-to-treat analyses. Results: Children with comorbid depression were the least likely to be free of their primary anxiety diagnosis at the end of treatment and follow-up. According to child and maternal reports, symptoms of anxiety decreased similarly over time in all groups, but children with comorbid mood disorders scored significantly highest at all time points. Examining the effects of anxiety treatment on comorbid disorders showed that comorbid mood disorders, but not externalizing disorders, decreased significantly over time. Conclusions: The existence of comorbid disorders does not appear to affect the rate or extent of response to cognitive-behavioral treatment for child anxiety. However, comorbidity has a marked influence on the endpoint of treatment. Children with nonanxiety comorbidity and especially with comorbid mood disorders exhibit greater severity at the outset and remain worse after treatment. On the positive side, treatment for anxiety disorders appears to decrease comorbid mood disorders, although it has less effect on comorbid externalizing disorders. J. Am. Acad. Child Adolesc. Psychiatry; 2012;52(1):47-56.