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Cohen SE, de Boer A, Storosum BWC, Mattila TK, Niemeijer MJ, Geller DA, Denys D, Zantvoord JB. Systematic Review and Meta-analysis of Individual Participant Data: Randomized, Placebo-Controlled Trials of Selective Serotonin Reuptake Inhibitors for Pediatric Obsessive-Compulsive Disorder. J Am Acad Child Adolesc Psychiatry 2025:S0890-8567(25)00002-4. [PMID: 39799995 DOI: 10.1016/j.jaac.2025.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 11/20/2024] [Accepted: 01/03/2025] [Indexed: 01/15/2025]
Abstract
OBJECTIVE Selective serotonin reuptake inhibitors (SSRIs) are the first choice in pharmacotherapy for children and adolescents with obsessive-compulsive disorder (OCD). SSRI trials for pediatric OCD have not been investigated using individual participant data (IPD), which is crucial for detecting patient-level effect modifiers. This study performed an IPD meta-analysis of efficacy of SSRIs compared with placebo and a meta-regression on baseline patient characteristics that might modify efficacy. METHOD Crude participant data from short-term, randomized, placebo-controlled SSRI trials for pediatric OCD were obtained from the registry of the Dutch regulatory authority. A systematic literature search was also performed, and authors were approached to provide IPD. A 1- and 2-stage analysis was conducted, with change on Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) as the primary outcome. Odds ratio (OR) with ≥35% CY-BOCS reduction was used as the responder outcome measure. Modifying effect of age, sex, weight, duration of illness, family history, and baseline symptom severity was examined. The Cochrane RoB 2.0 tool was used to examine methodological rigor, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to examine certainty of evidence. RESULTS Data were obtained from 4 studies comprising 614 patients. The sample represented 86% of all participants ever included in double-blind placebo-controlled SSRI trials for pediatric OCD. Meta-analysis showed reduction of 3.0 CY-BOCS points compared with placebo (95% CI 2.5-3.5), corresponding to a small effect size (0.38 Hedges' g). Analysis of response showed an odds ratio of 1.89 (95% CI 1.45-2.45). Of all possible modifiers, severity was correlated negatively with odds ratio for response (β = -0.92, p = .0074). Risk of bias was generally low. All studies were performed in North America with an overrepresentation of White participants. Findings were limited by inability to include data on additional variables such as socioeconomic status and comorbidities. CONCLUSION This IPD meta-analysis showed a small effect size of SSRIs in pediatric OCD, with baseline severity as a negative modifier of response. Generalizability of findings might be limited by selective inclusion of White, North American participants. STUDY REGISTRATION INFORMATION Patient Characteristics and Efficacy of SSRI Treatment in Children and Adolescents With Obsessive Compulsive Disorder: An Individual Participant Data Meta-analysis of Randomized, Placebo-Controlled Trials; https://www.crd.york.ac.uk; CRD42023486079.
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Affiliation(s)
- Sem E Cohen
- Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands.
| | - Anthonius de Boer
- Medicines Evaluation Board, Utrecht, the Netherlands; Utrecht University, Utrecht, the Netherlands
| | - Bram W C Storosum
- Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands; Arkin Institute for Mental Health, Amsterdam, the Netherlands
| | | | | | - Daniel A Geller
- Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts
| | - Damiaan Denys
- Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands; Arkin Institute for Mental Health, Amsterdam, the Netherlands
| | - Jasper B Zantvoord
- Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands
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Kiss E, de Oliveira OR, Wittmann E, Herczegh Z, Kapornai K. The effect of psychological and behavioral problems on the quality of life of children and adolescents based on self-reports and proxy reports. Health Qual Life Outcomes 2024; 22:84. [PMID: 39379992 PMCID: PMC11463092 DOI: 10.1186/s12955-024-02299-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 09/19/2024] [Indexed: 10/10/2024] Open
Abstract
PURPOSE Investigations of the quality of life (QoL) of young people have shown that psychological and behavioral problems are associated with lower subjective well-being. The QoL ratings of children and adolescents based on self-reports and proxy reports are significantly different. The aim of the present study was to examine youth self-reported and parent proxy-reported QoL and investigate the effects of age, gender and psychological/behavioral symptoms on the QoL reports of youth. We hypothesized that self-reported emotional and anxiety problems influence self-reported QoL, while proxy-reported behavioral problems influence proxy reports of QoL. METHODS The sample consisted of 284 parent-child pairs. Youths were between the ages of 11 and 18 years, the mean age was 14.3 (SD 2.1) years, and 35.6% were males. The Inventory of Life Quality (ILK) scale was used to measure QoL, and the Strengths and Difficulties Questionnaire was used to assess psychological and behavioral problems. RESULTS Males had higher self-reported QoL than females, and younger children had better QoL than older children. Emotional peer problems and hyperactivity reported by youth and hyperactivity and conduct problems reported by parents predicted youth self-rated ILK. Only parent-reported psychological/behavioral problems predicted proxy-rated ILK. CONCLUSION The evaluation of QoL of children and adolescents should involve both self and proxy reports in order to capture the effects of various psychological/behavioral symptoms and the perspectives of both youth and parents.
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Affiliation(s)
- Enikő Kiss
- Department of Pediatrics and Pediatric Health Center, Child and Adolescent Psychiatry, University of Szeged, Szeged, Hungary.
| | | | - Eszter Wittmann
- Department of Pediatrics and Pediatric Health Center, Child and Adolescent Psychiatry, University of Szeged, Szeged, Hungary
| | - Zita Herczegh
- Department of Pediatrics and Pediatric Health Center, Child and Adolescent Psychiatry, University of Szeged, Szeged, Hungary
| | - Krisztina Kapornai
- Department of Pediatrics and Pediatric Health Center, Child and Adolescent Psychiatry, University of Szeged, Szeged, Hungary
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Cervin M, Højgaard DRMA, Jensen S, Torp NC, Skarphedinsson G, Nissen JB, Melin K, Borrelli DF, Hybel KA, Thomsen PH, Ivarsson T, Weidle B. A General Factor of Psychopathology Predicts Treatment and Long-Term Outcomes in Children and Adolescents With Obsessive-Compulsive Disorder. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00322-8. [PMID: 38960031 DOI: 10.1016/j.jaac.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 04/20/2024] [Accepted: 06/24/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE Children and adolescents with obsessive-compulsive disorder (OCD) are at risk for long-term adversity, but factors influencing long-term outcomes are unclear. A general factor of psychopathology, often referred to as the p factor, captures variance shared by all mental disorders and has predicted long-term outcomes in youth with anxiety and depressive disorders. The p factor has never been examined in relation to outcomes in pediatric OCD. Here, we examine whether the p factor predicts 4 important outcomes over both short and long durations in youth with OCD. METHOD We used data from the Nordic Long-term OCD Treatment Study (NordLOTS), in which youth with OCD (N = 248, mean age = 12.83 years [SD = 2.72], 51.6% girls) received exposure-based cognitive-behavioral therapy. The p factor was estimated using parent-reported Child Behavior Checklist data at baseline and was examined in relation to clinician-rated OCD severity, clinician-rated psychosocial functioning, self-reported depressive symptoms, and self- and parent-reported quality of life directly after treatment and 1, 2, and 3 years after treatment. RESULTS The p factor was associated with acute treatment outcomes for OCD severity and psychosocial functioning, but not for depressive symptoms and quality of life. For the long-term outcomes, the p factor was significantly associated with all outcomes except OCD severity. The p factor outperformed traditional psychiatric comorbidity as a predictor of long-term outcomes. CONCLUSION Youth with OCD who experience symptoms across multiple psychiatric domains have poorer long-term outcomes. Compared to traditional classification of psychiatric diagnoses, assessing psychopathology using a dimensional p factor approach may be advantageous for informing prognosis in pediatric OCD.
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Affiliation(s)
| | | | | | - Nor Christian Torp
- Vestre Viken Hospital, Drammen, Norway; Akershus University Hospital, Oslo, Norway
| | | | | | - Karin Melin
- University of Gothenburg, Gothenburg, Sweden
| | | | | | | | | | - Bernhard Weidle
- Norwegian University of Science and Technology, Trondheim, Norway; St. Olav's University Hospital, Trondheim, Norway
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Wang B, Skarphedinsson G, Weidle B, Babiano-Espinosa L, Wolters L, Arntzen J, Skokauskas N. Secondary outcomes of enhanced cognitive behavioral therapy (eCBT) for children and adolescents with obsessive-compulsive disorder. Front Hum Neurosci 2024; 17:1330435. [PMID: 38259330 PMCID: PMC10800953 DOI: 10.3389/fnhum.2023.1330435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Background Obsessive-compulsive disorder (OCD) is a debilitating mental health condition usually presenting with a high degree of comorbid symptoms in the majority of cases. Although face-to-face cognitive-behavioral therapy (CBT) is considered the therapeutic golden standard for pediatric OCD, its accessibility, availability, and consistency in delivery are still limited. To address some of these challenges, an enhanced CBT (eCBT) package was created and introduced. This study explored eCBT's broad-based impact on OCD-related comorbid symptoms, functional impairment, quality of life and family accommodation among youth with OCD. Methods This open trial involved 25 pediatric patients with OCD (7-17 years), assessed between January 2018 to February 2020. All patients received eCBT for 14 weeks. Secondary outcomes were assessed at baseline, post-treatment, and 3-, 6-, and 12-month follow-up co-occurring symptoms were evaluated using the Strengths and Difficulties Questionnaire (SDQ), Screen for Child Anxiety-Related Emotional Disorders (SCARED), and Mood and Feelings Questionnaire (MFQ). Quality of life was measured using the KINDL-R, functional impairment through the Child Obsessive-Compulsive Impact Scale Revised (COIS-R), and family accommodation by the Family Accommodation Scale (FAS). Linear mixed-effects models were applied to analyze treatment effects. Results Results indicated a significant decrease in OCD-related comorbid symptoms post-treatment, with SDQ mean reduce of 3.73 (SE = 1.10, child) and 4.14 (SE = 1.19, parent), SCARED mean reduce of 10.45 (SE = 2.52, child) and 8.40 (SE = 2.82, parent), MFQ mean reduce of 3.23 (SE = 1.11, child) and 2.69 (SE = 1.18, parent). Family accommodation declined with clinician scored FAS mean reduction of 13.25 (SE = 2.31). Quality-of-Life improved significantly post-treatment, with KINDL mean increase of 8.15 (SE = 2.87, children), and 10.54 (SE = 3.07, parents). These positive improvements were further amplified at the 3-month follow-up and remained consistent at the 12-month follow-up. Conclusion A significant reduction was observed in all secondary outcomes employed and OCD-related functional impairments from baseline to post-treatment, which was maintained through 12-month follow-up. These results imply that after receiving eCBT, children and adolescents experienced substantial decrease in the negative impacts of OCD-related symptoms on their daily life, including home, school, and social interactions.
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Affiliation(s)
- Bo Wang
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | | | - Bernhard Weidle
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
| | - Lucía Babiano-Espinosa
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
| | | | - Jostein Arntzen
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
| | - Norbert Skokauskas
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of Science and Technology, Trondheim, Norway
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Skarphedinsson G, Speight Kristínardóttir SÓ, Gústavsson SM, Sigurðsson JF. Parents' experience and views on the assessment and treatment of children with OCD within the public mental health system in Iceland: a qualitative study. Nord J Psychiatry 2024; 78:22-29. [PMID: 37694737 DOI: 10.1080/08039488.2023.2254758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/08/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE Obsessive-compulsive disorder (OCD) in children can lead to long-lasting symptoms and access to evidence-based evaluation and treatment is crucial for its prevention. In Iceland, the law guarantees public access to the highest quality healthcare services. To date, no study has evaluated the services available for children with OCD within the national healthcare system (NMHS). This qualitative study explored the experiences of parents navigating the Icelandic NMHS for their children with OCD. METHOD AND MATERIALS Seven parents who had sought services within the NMHS for their children diagnosed with OCD at private clinics were interviewed using a semi-structured interview. The responses were analyzed using thematic framework analysis. RESULTS Nineteen themes were identified, including three overarching themes and eight overarching sub-themes, and eight sub-themes within them. A prevalent theme was the giving up on the national mental healthcare system due to parents' experiences of accessing mental healthcare for their children being challenging. Other issues faced by parents included a lack of knowledge on where to seek help, inadequate evaluation of the issue, and the lack of access to psychotherapy for their children. The healthcare workers' responses and recommendations also resulted in parents seeking treatment at private clinics. CONCLUSIONS These findings underscore the need for clearer pathways for seeking help, improved access to trained healthcare workers, and a more centralized evaluation process. These insights can potentially guide future research and policy decisions to better support families dealing with childhood OCD in Iceland.
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Affiliation(s)
| | | | | | - Jón Friðrik Sigurðsson
- Department of Psychology, Reykjavik University, Reykjavík, Iceland
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
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Thapa Bajgain K, Amarbayan M, Wittevrongel K, McCabe E, Naqvi SF, Tang K, Aghajafari F, Zwicker JD, Santana M. Patient-reported outcome measures used to improve youth mental health services: a systematic review. J Patient Rep Outcomes 2023; 7:14. [PMID: 36788182 PMCID: PMC9928989 DOI: 10.1186/s41687-023-00556-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/31/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are standardized and validated self-administered questionnaires that assess whether healthcare interventions and practices improve patients' health and quality of life. PROMs are commonly implemented in children and youth mental health services, as they increasingly emphasize patient-centered care. The objective of this study was to identify and describe the PROMs that are currently in use with children and youth living with mental health conditions (MHCs). METHODS Three databases (MEDLINE, EMBASE, and PsycINFO) were systematically searched that used PROMs with children and youth < 18 years of age living with at least one diagnosed MHC. All methods were noted according to Preferred Reporting Items for Systematic reviews and Meta-Analysis. Four independent reviewers extracted data, which included study characteristics (country, year), setting, the type of MHC under investigation, how the PROMs were used, type of respondent, number of items, domain descriptors, and the psychometric properties. RESULTS Of the 5004 articles returned by the electronic search, 34 full-texts were included in this review. This review identified both generic and disease-specific PROMs, and of the 28 measures identified, 13 were generic, two were generic preference-based, and 13 were disease-specific. CONCLUSION This review shows there is a diverse array of PROMs used in children and youth living with MHCs. Integrating PROMs into the routine clinical care of youth living with MHCs could improve the mental health of youth. Further research on how relevant these PROMs are children and youth with mental health conditions will help establish more uniformity in the use of PROMs for this population.
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Affiliation(s)
- Kalpana Thapa Bajgain
- grid.22072.350000 0004 1936 7697Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Mungunzul Amarbayan
- grid.22072.350000 0004 1936 7697School of Public Policy, University of Calgary, Calgary, AB Canada
| | - Krystle Wittevrongel
- grid.22072.350000 0004 1936 7697School of Public Policy, University of Calgary, Calgary, AB Canada
| | - Erin McCabe
- grid.22072.350000 0004 1936 7697School of Public Policy, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Syeda Farwa Naqvi
- grid.22072.350000 0004 1936 7697Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Karen Tang
- grid.22072.350000 0004 1936 7697Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB Canada
| | - Fariba Aghajafari
- grid.22072.350000 0004 1936 7697Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB Canada
| | - Jennifer D. Zwicker
- grid.22072.350000 0004 1936 7697School of Public Policy, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Faculty of Kinesiology, University of Calgary, Calgary, AB Canada
| | - Maria Santana
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, Canada.
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