Pediatric anxiety: Pharmacotherapy and psychotherapy utilization and serious adverse outcomes

 描述(申请人提供)：焦虑症是儿童中最常见的精神疾病之一，与导致功能障碍和功能障碍的症状有关。对焦虑进行有效的早期治疗可能会减少其负面影响，并降低其在成年后的持久性。根据随机对照试验证据，推荐将抗抑郁药类选择性5-羟色胺再摄取抑制剂(SSRIs)作为治疗儿童功能性焦虑症的一线药物。目前尚不清楚患有焦虑症的儿童开始服用处方药是否符合指导方针。焦虑症儿童的严重不良后果的负担也是未知的。鉴于认知行为疗法和SSRIs的结合已被证明在治疗中重度焦虑的儿童方面比单独使用SSRIs和单独的心理疗法具有优势，因此假设与单一疗法相比，接受联合疗法的儿童可能会经历更少的严重不良后果。增加与医疗保健提供者(即接受联合治疗的儿童)的接触也可能导致改善服药依从性。这项拟议的研究将描述2004年至2013年期间被诊断为非强迫症焦虑症的儿童(3-17岁)的焦虑症处方药使用情况、服药时间以及在开始服药前后使用心理治疗的频率(目标1)。将评估患有焦虑症的儿童的严重不良结局的比率，以及严重不良结局是否因治疗类型不同而不同：联合疗法(SSRI+心理疗法)与SSRI单一疗法和心理疗法单一疗法，以及结果是否因共病抑郁状态而不同(目标2)。评估的严重不良后果将包括治疗的自我伤害事件、与精神健康相关的住院和急诊室就诊。最后，这项拟议的研究将评估患有焦虑的儿童对SSRI的依从性，以及联合疗法和SSRI单一疗法(目标3)儿童之间的依从性是否存在差异。拟议的观察性研究将利用行政索赔数据来源，提供真实世界人口、足够的样本量和纵向数据，以有效和高效地解决研究问题。这项研究的结果将为进一步的工作提供信息，并将帮助提供者、患者和照顾者优化治疗，将严重不良后果的风险降至最低。

 DESCRIPTION (provided by applicant): Anxiety disorders are one of the most common mental illnesses in children and are associated with symptoms causing impairment and poor functioning. Effective early treatment of anxiety may reduce its negative impact and reduce its persistence into young adulthood. The antidepressant class selective serotonin reuptake inhibitors (SSRIs) are recommended as the first line medication treatment for children with functional impairing anxiety disorders, based on randomized controlled trial evidence. It is unknown whether children with anxiety initiate prescription medication concordant with guidelines. The burden of serious adverse outcomes in children with anxiety is also unknown. Given that the combination of cognitive behavioral therapy and SSRIs has been shown to offer an advantage over SSRIs alone and psychotherapy alone in treating children with moderate to severe anxiety, it is hypothesized that children receiving combination therapy may experience reduced serious adverse outcomes compared to children on mono-therapy. Increased contact with a healthcare provider (i.e. children on combination therapy) may also result in improved medication adherence. The proposed study will describe prescription medication utilization for anxiety, how long the medications are taken, and the frequency in which psychotherapy is used surrounding medication initiation in children (3-17 years) with a non-OCD anxiety diagnosis from 2004-2013 (Aim 1). The rate of serious adverse outcomes in children with anxiety and whether serious adverse outcomes vary by treatment type: combination therapy (SSRI + psychotherapy) vs. SSRI mono-therapy and psychotherapy mono-therapy, and whether results differ by co-morbid depression status will be estimated (Aim 2). The serious adverse outcomes evaluated will include treated self-harm events, mental health related hospitalizations, and emergency room visits. Lastly the proposed study will estimate SSRI adherence in children with anxiety and whether adherence varies between children on combination therapy vs. SSRI mono-therapy (Aim 3). The proposed observational study will utilize an administrative claims datasource providing a real world population, adequate sample size, and longitudinal data to effectively and efficiently address the study questions. Results from this study will inform further work and will assist providers, patients, and caregivers in optimizing treatment to minimize the risk of serious adverse outcomes.