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Rabner J, Olino TM, Albano AM, Keeton CP, Sakolsky D, Birmaher B, Piacentini J, Peris TS, Compton SN, Gosch E, Ginsburg GS, Pinney EL, Kendall PC. Substance use outcomes from the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS). J Child Psychol Psychiatry 2024. [PMID: 38217328 DOI: 10.1111/jcpp.13926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Substance use problems and anxiety disorders are both highly prevalent and frequently cooccur in youth. The present study examined the benefits of successful anxiety treatment at 3-12 years after treatment completion on substance use outcomes (i.e. diagnoses and lifetime expected use). METHODS The sample was from the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), a naturalistic follow-up study to the Child/Adolescent Anxiety Multimodal Study (CAMS) which randomized youth to cognitive behavioral therapy (CBT; Coping cat), medication (sertraline), their combination, or pill placebo. The first CAMELS visit occurred an average of 6.5 years following CAMS randomization. Participants were 319 youth (65.4% of the CAMS sample), aged 7-17 years at CAMS baseline assessment with a mean age of 17.6 years (range: 11-26 years) at the time of the first CAMELS follow-up. Substance use outcomes included diagnoses as well as lifetime substance use (i.e. alcohol and tobacco use). RESULTS Eleven of 319 (3.4%) CAMELS participants were diagnosed with a substance use disorder at the initial follow-up visit. When compared to the population lifetime rate of 11.4%, the rate of diagnoses in the posttreated sample was significantly lower. Additionally, rates of lifetime alcohol use were lower than population rates at the initial and final follow-up visits. Rates of lifetime tobacco use were similarly lower than lifetime population rates at the initial visit (driven by significantly lower rates in the CBT treatment condition), but higher by the final visit. Furthermore, treatment remission (but not treatment response) was associated with a lower rate of substance use diagnoses at the initial follow-up visit, although rates of lifetime alcohol and tobacco use did not differ by treatment outcome. CONCLUSIONS Anxiety treatments confer a beneficial impact on problematic substance use (i.e. diagnoses) as well as on expected substance use (i.e. alcohol and tobacco use) for on average, a period of 6.5 years.
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Affiliation(s)
- Jonathan Rabner
- Department of Psychology and Neuorscience, Temple University, Philadelphia, PA, USA
| | - Thomas M Olino
- Department of Psychology and Neuorscience, Temple University, Philadelphia, PA, USA
| | - Anne Marie Albano
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Courtney P Keeton
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Tara S Peris
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Scott N Compton
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth Gosch
- Department of Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | | | - Philip C Kendall
- Department of Psychology and Neuorscience, Temple University, Philadelphia, PA, USA
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Woodard GS, Casline E, Ehrenreich-May J, Ginsburg GS, Jensen-Doss A. Consultation as an Implementation Strategy to Increase Fidelity of Measurement-Based Care Delivery in Community Mental Health Settings: An Observational Study. Adm Policy Ment Health 2023:10.1007/s10488-023-01321-7. [PMID: 38052929 DOI: 10.1007/s10488-023-01321-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/07/2023]
Abstract
Regularly administering outcome measures to clients to inform clinical decision making, referred to as measurement-based care (MBC), has the potential to improve mental health treatment due to its applicability across disorders and treatment settings. Given the utility of MBC, understanding predictors of high-fidelity MBC implementation is important. Training and consultation are widely used implementation strategies to increase the fidelity of evidence-based practice delivery but have rarely been studied with MBC. The current study will examine the relationship between time clinicians spent discussing a case in consultation ("dosage") and MBC fidelity. Thirty clinicians and 56 youth were in the MBC condition of a randomized controlled trial and completed baseline questionnaires. Consultation dosage was extracted from call notes. MBC fidelity was measured using the implementation index, which combines rates of administering and viewing questionnaires, using objective data from the online MBC system. Multi-level modeling was used. Greater consultation dosage significantly predicted a higher implementation index (ß = 0.27, SE = 0.06, p < .001). For every 30 min spent discussing a case in consultation, the case's MBC fidelity increased by 8.1%. Greater consultation dosage significantly predicted higher rates of administration (ß = 0.07, SE = 0.03, p = 0.033) and feedback report viewing (ß = 0.24, SE = 0.06, p < .001). More consultation at the case level predicts greater MBC fidelity using objective measures. The greatest impact was increasing the clinician feedback report viewing rate. The results of this study can help inform future efforts to increase the fidelity with which MBC is delivered and to make consultation as efficient and effective as possible.
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Affiliation(s)
- Grace S Woodard
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33146, USA.
| | - Elizabeth Casline
- Northwestern University Feinberg School of Medicine, 420 E. Superior Street, Chicago, IL, 60611, USA
| | - Jill Ehrenreich-May
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33146, USA
| | - Golda S Ginsburg
- University of Connecticut School of Medicine, 65 Kane Street Room 3022, West Hartford, CT, 06119, USA
| | - Amanda Jensen-Doss
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33146, USA
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Jensen-Doss A, Woodard G, Patel-Syed Z, Ehrenreich-May J, Rosenfield D, Ginsburg GS. External and Internal Validity Considerations in Youth Effectiveness Trials: Lessons Learned from the COMET Study. J Clin Child Adolesc Psychol 2023; 52:735-749. [PMID: 37947431 PMCID: PMC10655847 DOI: 10.1080/15374416.2023.2272958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Effectiveness trials aim to increase the generalizability and public health impact of interventions. However, challenges associated with this design present threats to external and internal validity. This paper illustrates these challenges using data from a two-site randomized effectiveness trial, the Community Study of Outcome Monitoring for Emotional Disorders in Teens (COMET) and presents recommendations for future research. METHOD COMET was a randomized effectiveness trial conducted in 19 community mental health clinics in two states comparing three interventions: treatment as usual (TAU), TAU with measurement-based care (TAU+), and the Unified Protocol forTransdiagnostic Treatment of Emotional Disorders in Adolescents with MBC (UPA). Participants included 176 clinicians (mean age = 35.5; 85.8% cisgender female; 53.0% racially and/or ethnically minorized) and 196 adolescents (mean age = 14.7; 65.3% cisgender female; 69.4% racially and/or ethnically minorized). Analyses outlined participant flow from recruitment to study completion, described participant characteristics, and examined site differences. RESULTS Analysis of participant flow suggested that recruitment and retention of clinicians and adolescents was challenging, raising questions about whether participants were representative of participating clinics. Both the clinician and adolescent samples were racially and ethnically diverse and adolescents were low income and clinically complex. Significant site differences were observed in clinician and adolescent characteristics. CONCLUSIONS While this study was successful in recruiting a diverse and historically under-represented sample, difficulties in recruitment and retention raise questions about external validity and site differences present challenges to internal validity of study findings. Suggestions for future effectiveness studies, drawing from implementation science approaches, are discussed.
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Affiliation(s)
| | - Grace Woodard
- University of Miami Department of Psychology, Coral Gables, FL, USA
| | - Zabin Patel-Syed
- Northwestern University Fienberg School of Medicine, Center for Dissemination and Implementation Science, Chicago, IL, USA
| | | | | | - Golda S. Ginsburg
- University of Connecticut School of Medicine, Department of Psychiatry, Farmington, CT, USA
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Phillips DA, Ginsburg GS, Ehrenreich-May J, Jensen-Doss A. Treatment Engagement in Adolescents: The Associations of Sociodemographic Characteristics, Caregiver Perceived Barriers, and Clinical Impairment. J Clin Child Adolesc Psychol 2023:1-14. [PMID: 37347999 PMCID: PMC10739653 DOI: 10.1080/15374416.2023.2222387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To examine the associations between sociodemographic characteristics, perceived barriers to treatment, clinical impairment, and youth treatment engagement. METHOD Participants included 196 families (youth: ages 12 to 18; 64.3% cis-gender female; 23.5% Black, 60.7% White, and 12.2% Mixed/Other race; 41.3% Hispanic or Latinx ethnicity) recruited as part of a comparative effectiveness trial for adolescent anxiety and depression. Self-report measures of sociodemographic characteristics and caregiver perceived barriers were completed at intake. Youth clinical impairment was assessed at baseline via clinical interview. Measures of engagement were collected throughout treatment, including initiation status, session attendance, and termination status. Relationships were examined using analyses of variances and hierarchal linear and logistic modeling. RESULTS Perceived barriers did not differ by sociodemographic characteristics. Greater perceived stressors and obstacles predicted fewer sessions attended and a lower likelihood of successful termination. Youth of caregivers with an advanced degree and those with caregivers who were employed part time attended more sessions and were more likely to initiate and terminate treatment successfully compared to youth with caregivers of a lower education level or student or unemployed status. At higher levels of youth clinical impairment, greater perceived treatment demands and issues predicted reduced likelihood of treatment initiation. CONCLUSIONS Perceived barriers, sociodemographic characteristics, and clinical impairment were all associated with levels of engagement in the treatment process. Baseline and continued assessment of perceived and experienced barriers to treatment may promote individualized strategies for families identified as at-risk for reduced engagement.
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Affiliation(s)
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine
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Harrison TJ, Ginsburg GS, Smith IC, Orlando CM. Youth stress generation: an examination of the role of anxiety, anxiety symptoms and cognitive distortions. Anxiety Stress Coping 2023; 36:304-319. [PMID: 35576123 PMCID: PMC9666622 DOI: 10.1080/10615806.2022.2076083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 04/26/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Stress generation suggests a reciprocal relationship between depression and prospective stressful life events. However, the applicability of stress generation to anxiety disorders has been understudied, particularly among youth. We address this gap by examining stress generation in youth at high-risk of developing anxiety disorders. METHODS Participants were one-hundred thirty-six at-risk youth (M age = 8.69, 84.6% Caucasian; 55.9% female), each of whom had a parent with an anxiety disorder. We examined the role of an anxiety disorder diagnosis, anxiety symptoms, and cognitive distortions in youth's prospective one and six-year stressful life events (i.e., stress generation). RESULTS Anxiety symptoms and cognitive distortions were significant predictors of one-year total dependent stress. Anxiety diagnosis and anxiety symptoms were significant predictors of one-year dependent interpersonal stress. Anxiety diagnosis and anxiety symptoms were significant predictors of six-year independent stress. CONCLUSION Support for the stress generation model was found in high-risk youth, but only over a one-year period. This suggests important effects of anxiety and cognitive distortions on stress generation, though their implications might be time-capped.
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Affiliation(s)
| | | | - Isaac C. Smith
- University of Connecticut Health Center, Department of Psychiatry
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Bai S, Rolon-Arroyo B, Walkup JT, Kendall PC, Ginsburg GS, Keeton CP, Albano AM, Compton SN, Sakolsky D, Piacentini J, Peris TS. Anxiety symptom trajectories from treatment to 5- to 12-year follow-up across childhood and adolescence. J Child Psychol Psychiatry 2023. [PMID: 37005705 DOI: 10.1111/jcpp.13796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE The current study examined trajectories of anxiety during (a) acute treatment and (b) extended follow-up to better characterize the long-term symptom trajectories of youth who received evidence-based intervention for anxiety disorders using a person-centered approach. METHOD Participants were 319 youth (age 7-17 years at enrollment), who participated in a multicenter randomized controlled trial for the treatment of pediatric anxiety disorders, Child/Adolescent Anxiety Multimodal Study, and a 4-year naturalistic follow-up, Child/Adolescent Anxiety Multimodal Extended Long-term Study, an average of 6.5 years later. Using growth mixture modeling, the study identified distinct trajectories of anxiety across acute treatment (Weeks 0-12), posttreatment (Weeks 12-36), and the 4-year-long follow-up, and identified baseline predictors of these trajectories. RESULTS Three nonlinear anxiety trajectories emerged: "short-term responders" who showed rapid treatment response but had higher levels of anxiety during the extended follow-up; "durable responders" who sustained treatment gains; and "delayed remitters" who did not show an initial response to treatment, but showed low levels of anxiety during the maintenance and extended follow-up periods. Worse anxiety severity and better family functioning at baseline predicted membership in the delayed remitters group. Caregiver strain differentiated short-term responders from durable responders. CONCLUSIONS Findings suggest that initial response to treatment does not guarantee sustained treatment gains over time for some youth. Future follow-up studies that track treated youth across key developmental transitions and in the context of changing social environments are needed to inform best practices for the long-term management of anxiety.
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Affiliation(s)
- Sunhye Bai
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | | | - John T Walkup
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Evanston, IL, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Courtney P Keeton
- Department of Psychiatry and Behavioral Services, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, University of California Los Angeles, Los Angeles, CA, USA
| | - Tara S Peris
- Division of Child and Adolescent Psychiatry, University of California Los Angeles, Los Angeles, CA, USA
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Rabner JC, Olino TM, Albano AM, Ginsburg GS, Compton SN, Piacentini J, Sakolsky D, Birmaher B, Gosch E, Kendall PC. Do youth anxiety measures assess the same construct consistently throughout treatment? Results are...complicated. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01515-y. [PMID: 36856912 DOI: 10.1007/s10578-023-01515-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
Interventionists interpret changes in symptoms as reflecting response to treatment. However, changes in symptom functioning and the measurement of the underlying constructs may be reflected in reported change. Longitudinal measurement invariance (LMI) is a statistical approach that assesses the degree to which measures consistently capture the same construct over time. We examined LMI in measures of anxiety severity/symptoms [i.e., Pediatric Anxiety Rating Scale (PARS), Multidimensional Anxiety Scale for Children (MASC), Screen for Child Anxiety and Related Disorders (SCARED)] in anxious youth at baseline and posttreatment. Initial fit was inadequate for 27 of 38 baseline and posttreatment models, but model modifications resulted in acceptable fit. Tests of LMI supported scalar invariance for the PARS and many, but not all, MASC and SCARED subscales. Findings suggest that the PARS, and many MASC and SCARED subscales can accurately be used to measure change over time, however, others may reflect changes in measurement properties.
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Affiliation(s)
- Jonathan C Rabner
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA.
| | - Thomas M Olino
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Anne Marie Albano
- Department of Psychiatry, Columbia University, New York City, NY, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, West Hartford, CT, USA
| | - Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elizabeth Gosch
- Department of Clinical Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Philip C Kendall
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
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Casline EP, Ogle RR, Peris TS, Kendall PC, Piacentini J, Compton S, Keeton C, Ginsburg GS. Client-rated facilitators and barriers to long-term youth anxiety disorder recovery. J Clin Psychol 2022; 78:2164-2179. [PMID: 35687807 PMCID: PMC9561069 DOI: 10.1002/jclp.23400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/10/2022] [Accepted: 05/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study examined client ratings of 26 facilitators and barriers to anxiety improvement approximately 6 years after randomization to treatment for anxiety. METHOD 319 youth (average 17.12 years old; 82.1% Caucasian; 58.6% female) participated in the longitudinal follow-up study to child and adolescent anxiety multimodal study (CAMS), a randomized controlled trial of medication, cognitive-behavioral therapy (CBT), combination, and placebo. RESULTS Correcting for multiple comparisons, CBT components (i.e., problem solving, changing unhelpful thoughts, relaxation skills) were rated significantly more helpful among youth without, versus with, an anxiety disorder at follow-up. Barriers that differentiated youth with and without an anxiety disorder included being bullied and difficulty applying therapy content to new situations. Comparisons between youth with different anxiety disorder trajectories (e.g., stable remission, relapsed, or chronically ill) also revealed several differences. CONCLUSION Findings suggest that client-rated facilitators and barriers covary with anxiety disorder recovery and may serve as useful tools when evaluating long-term treatment efficacy.
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Affiliation(s)
| | - Robert R. Ogle
- Counseling Center, Yeshiva University, New York, NY, USA
| | - Tara S. Peris
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA
| | | | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA
| | - Scott Compton
- Department of Psychiatry and Behavioral Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Courtney Keeton
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Golda S. Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
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Casline E, Woodard G, Patel ZS, Phillips DA, Ehrenreich-May J, Ginsburg GS, Jensen-Doss A. Characterizing measurement-based care implementation using therapist report. Evid Based Pract Child Adolesc Ment Health 2022; 8:549-559. [PMID: 38031580 PMCID: PMC10683951 DOI: 10.1080/23794925.2022.2124555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
The effectiveness of measurement-based care (MBC), an evidence-based practice that uses regularly collected assessment data to guide clinical decision-making, is impacted by whether and how therapists use information from MBC tools in treatment. Improved characterization of how therapists use MBC in treatment sessions with youth is needed to guide implementation and understand variability in MBC effectiveness. To meet this need, this study examined therapists' sharing and discussion of MBC in treatment sessions. Thirty therapists were randomly assigned to the MBC condition as part of a comparative effectiveness trail of treatments for adolescent anxiety and depression. A qualitative content analysis was conducted on therapists' written explanations of changes made to the session based on the MBC data. Therapists reported sharing data with youth and caregivers in an average of 34.6% and 27.4% of sessions, respectively. Therapists reported incorporating MBC data in an average of 21.1% of sessions. When data were used, therapists predominately focused changes on short-term (e.g., current symptoms, treatment skill) rather than long-term (e.g., symptom progress, treatment goals) decision-making. Therapists inconsistently used MBC data, highlighting the need for improved training in and monitoring of how therapists use MBC in session to guide collaborative treatment decision-making with youth and caregivers.
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Affiliation(s)
| | - Grace Woodard
- University of Miami Department of Psychology, Coral Gables, FL, USA
| | - Zabin S. Patel
- University of Miami Department of Psychology, Coral Gables, FL, USA
| | | | | | - Golda S. Ginsburg
- University of Connecticut School of Medicine, Department of Psychiatry, Farmington, CT, USA
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Ginsburg GS, Pella JE, Slade E. Cost-Effectiveness Analysis of School-Based Treatments for Anxiety Disorders. J Ment Health Policy Econ 2022; 25:91-103. [PMID: 36128988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND School-based treatments for anxiety disorders are needed to address barriers to accessing community-based services. A key question for school administers are the costs related to these treatments. AIMS OF THE STUDY This study examined the cost-effectiveness of a school-based modular cognitive behavioral therapy (M-CBT) for pediatric anxiety disorders compared to school-based treatment as usual (TAU). METHODS Sixty-two school-based clinicians in Maryland and Connecticut were randomized (37 in CBT; 25 in TAU), trained, and enrolled at least one anxious student (148 students in CBT; 68 in TAU). Students (N = 216) were ages 6-18 (mean age 10.9); 63.9% were non-Hispanic White race-ethnicity; and 48.6% were female. Independent evaluators (IEs) assessed outcomes at post treatment and at a one-year follow up. Anxiety related costs included mental health care expenses and the opportunity costs of added caregiver time and missed school days. RESULTS The overall M-CBT ICER value of $6917/QALY reflected both lower costs for days absent from school (mean difference: $--117 per youth; p = 0.045) but also lower QALY ratings (mean difference: -0.024; p = 0.900) compared with usual school counseling. Among youth with more severe anxiety at baseline, M-CBT had a more favorable ICER ($-22,846/QALY). Other mental health care costs were similar between groups (mean difference: $-90 per youth; p = 0.328). DISCUSSION Although training school clinicians in M-CBT resulted in lower costs for school absences, evidence for the cost effectiveness of a modular CBT relative to existing school treatment for pediatric anxiety disorders was not robustly supported. Findings suggest school-based M-CBT is most cost effective for youth with the highest levels of anxiety severity and that M-CBT could help reduce the costs of missed school. Interpretations are limited due to use of retrospective recall, lack of data on medication use, and small sample size. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE Schools may benefit from providing specialized school-based services such as M-CBT for students with the highest levels of anxiety. IMPLICATIONS FOR HEALTH POLICIES Investment decisions by schools should take into account lower costs (related to school absences), the costs of training clinicians, and student access to CBT in the community. IMPLICATIONS FOR FURTHER RESEARCH Replication with a larger sample, service use diaries, and objective school and medical records over a longer period of time is warranted.
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Affiliation(s)
- Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, 65 Kane Street Room 2033, West Hartford, CT 06119, USA,
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Patel ZS, Philips D, Casline E, Aarons GA, Maxwell CA, Ginsburg GS, Ehrenreich-May J, Jensen-Doss A. WHO Participates in Effectiveness Research? A Comparison of Effectiveness Trial Clinicians to National Survey Samples. Adm Policy Ment Health 2022; 49:899-908. [PMID: 35701676 PMCID: PMC9393133 DOI: 10.1007/s10488-022-01202-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/13/2022]
Abstract
Findings from research participants in effectiveness treatment trials (i.e., randomized control trials conducted in community rather than research settings) are considered more generalizable than those from participants in efficacy trials. This is especially true for clinician participants, whose characteristics like attitudes towards evidence-based practices (EBPs) may impact treatment implementation and the generalizability of research findings from effectiveness studies. This study compared background characteristics, attitudes toward EBPs, and attitudes towards measurement-based care (MBC) among clinicians participating in a National Institute of Mental-Health (NIMH) funded effectiveness trial, the Community Study of Outcome Monitoring for Emotional Disorders in Teens (COMET), to clinician data from nationally representative U.S. survey samples. Results indicated COMET clinicians were significantly younger, less clinically experienced, and were more likely to have a training background in psychology versus other disciplines compared to national survey samples. After controlling for demographics and professional characteristics, COMET clinicians held more positive attitudes towards EBPs and MBC compared to national survey samples. Implications for implementation efforts are discussed.
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Affiliation(s)
- Zabin S Patel
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA.
| | - Dominique Philips
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA
| | - Elizabeth Casline
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA
| | - Colleen A Maxwell
- Department of Psychology, Temple University, Philadelphia, PA, 19122, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut, Farmington, CT, 06030, USA
| | | | - Amanda Jensen-Doss
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA
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Slade EP, Ginsburg GS, Riddle MA. Cost-benefit Analysis of the Coping and Promoting Strength Program. Prev Sci 2021; 22:1096-1107. [PMID: 34647197 DOI: 10.1007/s11121-021-01309-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/24/2022]
Abstract
This study sought to estimate the net benefits and return on investment (ROI, %) of the Coping and Promoting Strength (CAPS) program to families and insurers, respectively, using data from a multi-year follow up of 136 US families who had participated in a randomized efficacy trial of CAPS. CAPS is a brief parent-focused psychosocial intervention that was compared to information monitoring in the trial. Of the 136 original participants, 113 (83%) completed follow-up interviews 7.1 years, on average, after the CAPS study baseline (mean follow-up age: 15.8 years; range: 13.1 to 20.8 years). Parent-reported willingness-to-pay values and estimates of behavioral healthcare cost savings from delayed onset of anxiety were used to simulate the average net benefits of CAPS to families and insurance plans, respectively, assuming patients pay 20% coinsurance. Psychologists in private offices were expected to charge an average of approximately $195 per CAPS session or $1417 in total in 2020 dollars. The estimated family share of the total CAPS session cost was $283 per youth, while the insurer share was $1134 per youth. Given these costs, the CAPS intervention was estimated to result in average overall net benefits of $1033 per youth (95% CI: -$546 to $2611). Families gained $344 (95% CI: $232 to $455 per family) for an ROI of 121%. Insurance plans on average gained a net savings of $689 per youth (95% CI: -$778 to $2156 per youth) for an average ROI of 61%. In this multiyear follow-up of offspring of anxious parents, exposure to the CAPS pediatric anxiety prevention program was found to be more economically efficient than was waiting for an anxiety disorder to be diagnosed. ClinicalTrials.gov Identifier: NCT00847561.
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Affiliation(s)
- Eric P Slade
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Golda S Ginsburg
- School of Medicine, University of Connecticut, Farmington, CT, USA
| | - Mark A Riddle
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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13
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Ginsburg GS, Yun-Tein J, Riddle MA. Preventing the Onset of Anxiety Disorders in Offspring of Anxious Parents: A Six-Year Follow-up. Child Psychiatry Hum Dev 2021; 52:751-760. [PMID: 33070244 PMCID: PMC8285043 DOI: 10.1007/s10578-020-01080-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 12/01/2022]
Abstract
This study examined the effects of a family-based intervention Coping and Promoting Strength (CAPS) relative to a control condition, information-monitoring (IM), to prevent the onset of anxiety disorders in offspring of anxious parents six years after their initial assessment. One hundred thirty six families participated in the original randomized trial; 113 (83%) completed the one time follow-up assessment. Presence of anxiety disorders and severity of symptoms in offspring were assessed by masked evaluators using the Anxiety Disorders Interview Schedule; parents and offspring also completed questionnaires assessing offspring anxiety. Using the intention to treat sample from the original trial, Cox regression models showed significant intervention main effects in the rate of onset of anxiety disorders from baseline to follow-up (anxiety disorder: hazard ratio (HR) = 2.55, 95% CI: 1.54, 4.21) but growth curves suggest effects occurred within the first year after program completion. No group differences were found in the cumulative incidence of anxiety disorders at the six-year follow-up. Additional intervention appears needed to maintain the initial positive effects long-term to reduce the risk for downstream disability.Clinical Trials Registration: NCT00847561.
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Conroy K, Hong N, Poznanski B, Hart KC, Ginsburg GS, Fabiano GA, Comer JS. Harnessing Home-School Partnerships and School Consultation to Support Youth With Anxiety. Cognitive and Behavioral Practice 2021; 29:381-399. [PMID: 35812004 PMCID: PMC9267952 DOI: 10.1016/j.cbpra.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Youth with anxiety often experience significant impairment in the school setting. Despite the relevance and promise of addressing anxiety in schools, traditional treatment approaches to school-based anxiety often do not adequately address generalization to the school setting, or they require removing the student from the classroom to deliver time- and staff-intensive programs. Such programs often leave teachers and caregivers feeling ill-equipped to support the student with anxiety throughout the natural course of the school day. Given the heavy demands placed on teachers and documented burnout among school professionals, providing effective school supports requires collaborative partnerships among outpatient therapists/specialists, school personnel, and caregivers. Drawing from literature on collaborative models for externalizing problems, we offer recommendations for outpatient therapists and specialists working to implement evidence-based supports in school settings and promote home-school partnerships to benefit youth with anxiety in the school setting. Our recommendations touch upon several components of such school consultation, including (a) identification of key parties involved, (b) conducting a needs assessment, (c) collaborative goal setting and development of a fear hierarchy, (d) plan development and implementation (e.g., facilitating a school-based exposure mindset, promoting home-school communication, enhancing school relationships), and (e) progress monitoring and ongoing support. We conclude with a case example to bring these recommendations to life.
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15
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Crane ME, Norris LA, Frank HE, Klugman J, Ginsburg GS, Keeton C, Albano AM, Piacentini J, Peris TS, Compton SN, Sakolsky D, Birmaher B, Kendall PC. Impact of treatment improvement on long-term anxiety: Results from CAMS and CAMELS. J Consult Clin Psychol 2021; 89:126-133. [PMID: 33705168 DOI: 10.1037/ccp0000523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This article examined associations between change in youth and family characteristics during youth anxiety treatment and long-term anxiety severity and overall functioning. METHOD Participants (N = 488; age 7-17 years; 45% male; 82% white) were randomized to 12 weeks of cognitive behavioral therapy (Coping Cat), medication (sertraline), their combination, or pill placebo in the Child/Adolescent Anxiety Multimodal Study (CAMS). A subset participated in the naturalistic follow-up Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS; n = 319; 3.70-11.83 years post-treatment). The current secondary analyses examined how change in anxiety severity (Child Global Impression-Severity), overall functioning (Children's Global Assessment Scale), caregiver psychopathology (Brief Symptom Inventory), caregiver strain (Family Burden Assessment Scale), and family dysfunction (Brief Family Assessment Measure) during CAMS was associated with anxiety severity and overall functioning years later (M = 7.72 years). CAMS procedures were registered on clinialtrials.gov. RESULTS Improvements in factors related to functioning (i.e., overall functioning, family dysfunction, caregiver strain) were associated with improvements in anxiety severity in CAMELS (|βys| ≥ .04, ps ≤ .04). Improvements in factors related to psychopathology (i.e., anxiety severity, caregiver psychopathology) were associated with improvements in overall functioning in CAMELS (|βys| ≥ .23, ps ≤ .04). It was changes in each of the variables examined (rather than baseline values) that predicted anxiety severity and overall functioning. CONCLUSIONS Both youth and family factors play a significant role in long-term treatment outcomes. Therapists would be wise to monitor how these factors change throughout treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Bai S, Ricketts EJ, Thamrin H, Piacentini J, Albano AM, Compton SN, Ginsburg GS, Sakolsky D, Keeton CP, Kendall PC, Peris TS. Longitudinal Study of Sleep and Internalizing Problems in Youth Treated for Pediatric Anxiety Disorders. Res Child Adolesc Psychopathol 2021; 48:67-77. [PMID: 31506757 DOI: 10.1007/s10802-019-00582-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The current study examined prospective bidirectional links between dysregulated sleep, and anxiety and depression severity across 4 years, among youth with a history of anxiety disorder. Participants were 319 youth (age 11-26 years), who previously participated in a large multisite randomized controlled trial for the treatment of pediatric anxiety disorders, Child/Adolescent Anxiety Multimodal Study (CAMS), and subsequently enrolled in a naturalistic follow-up, Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), an average of 6.5 years later. They participated in four annual visits that included self-report items of dysregulated sleep and semi-structured multi-informant interviews of anxiety and depression. Dysregulated sleep was bidirectionally associated with clinician-rated anxiety and depression symptom severity across adolescence and young adulthood. However, these bidirectional relationships were attributable to youth mean levels of dysregulated sleep, and anxiety and depression severity over the 4 years. Elevations in dysregulated sleep at each visit, relative to mean levels, did not predict worse anxiety or depression severity 1 year later. Likewise visit-specific elevations in anxiety and depression severity, as opposed to average levels, did not predict higher levels of dysregulated sleep at the next visit. Having higher levels of dysregulated sleep or more severe internalizing problems across the four-year period, as opposed to reporting a relative increase in symptom severity at a particular visit, posed greater risk for poor mental health. Interventions should continue to assess and treat persistent sleep problems alongside anxiety and depression.
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Affiliation(s)
- Sunhye Bai
- Human Development and Family Studies, The Pennsylvania State University, 216 Health and Human Development, University Park, PA, 16802, USA. .,Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
| | - Emily J Ricketts
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Hardian Thamrin
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | | | - Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Courtney P Keeton
- Department of Psychiatry and Behavioral Services, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Tara S Peris
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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Kagan ER, Frank HE, Norris LA, Palitz SA, Chiappini EA, Knepley MJ, Crane ME, Philips KE, Ginsburg GS, Keeton C, Albano AM, Piacentini J, Peris T, Compton S, Sakolsky D, Birmaher B, Kendall PC. Antidepressant Use in a 3- to 12-Year Follow-up of Anxious Youth: Results from the CAMELS Trial. Child Psychiatry Hum Dev 2021; 52:41-48. [PMID: 32253545 PMCID: PMC7541463 DOI: 10.1007/s10578-020-00983-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The current study explored whether patient characteristics predicted patterns of antidepressant use (i.e., never used, single episode of use, or two or more episodes) in a naturalistic follow-up. Participants in the child/adolescent multimodal (CAMS) extended long-term study. (n = 318) indicated medication use over the course of eight follow-up visits, 3-12 years after receiving treatment in CAMS. 40.6% of participants reported never using an antidepressant during follow-up, 41.4% reported a single episode of antidepressant use, and 18.0% reported multiple episodes of antidepressant use. Greater baseline anxiety severity marginally predicted a single episode of antidepressant use; baseline depression severity predicted multiple episodes of use. Reasons for discontinuing antidepressants included perceived ineffectiveness (31.8%), side effects (25.5%), and improvement in symptoms (18.5%). Exploratory analyses examined predictors of medication use. Findings suggest that antidepressant use is common among anxious youth, as is discontinuation of antidepressant use. Clinical implications and future directions are discussed.
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Affiliation(s)
- Elana R. Kagan
- Department of Behavioral Psychology, Kennedy Krieger Institute/Johns Hopkins School of Medicine, Baltimore, MD
| | - Hannah E. Frank
- Department of Psychology, Temple University, Philadelphia, PA
| | | | | | | | - Mark J. Knepley
- Department of Psychology, Temple University, Philadelphia, PA
| | | | | | - Golda S. Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, West Harford, CT
| | - Courtney Keeton
- Division of Child & Adolescent Psychiatry, Johns Hopkins, Baltimore, MD
| | | | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA
| | - Tara Peris
- Department of Psychiatry, UCLA, Los Angeles, CA
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
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18
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Caron EB, Drake KL, Stewart CE, Muggeo MA, Ginsburg GS. Intervention Adherence and Self-Efficacy as Predictors of Child Outcomes in School Nurse-Delivered Interventions for Anxiety. J Sch Nurs 2020; 38:249-258. [PMID: 32410495 DOI: 10.1177/1059840520925522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study examined the association between two implementation factors, nurse-reported intervention adherence and self-efficacy, and children's outcomes in school nurse-delivered anxiety interventions. Data were collected in a pilot randomized controlled effectiveness trial with 54 children and 21 school nurses. Nurses implemented either a cognitive behavioral or relaxation-skills-only intervention. Nurse questionnaires assessed implementation factors. Independent evaluators assessed changes in children's anxiety symptoms at postintervention and at 3-month follow-up using clinical improvement and global functioning scales. Regression analyses indicated that greater intervention adherence was associated with greater anxiety symptom improvement at follow-up. Nurse self-efficacy interacted with intervention group, such that nurses with higher self-efficacy who implemented the cognitive behavioral intervention tended to have children show improvement and higher postintervention functioning. The impact of implementation factors on children's outcomes may differ depending on intervention type. Self-efficacy may be important for nurses using relatively complex interventions. Intervention adherence should be supported through training and consultation.
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Affiliation(s)
- E B Caron
- Department of Psychological Science, Fitchburg State University, MA, USA
| | - Kelly L Drake
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA.,Anxiety Treatment Center of Maryland, Columbia, MD, USA
| | - Catherine E Stewart
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | | | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, West Hartford, CT, USA
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Ginsburg GS, Pella JE, Pikulski PJ, Tein JY, Drake KL. School-Based Treatment for Anxiety Research Study (STARS): a Randomized Controlled Effectiveness Trial. J Abnorm Child Psychol 2020; 48:407-417. [PMID: 31749064 DOI: 10.1007/s10802-019-00596-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The current study compared the effectiveness of a school-clinician administered cognitive behavioral treatment (CBT) to treatment as usual (TAU) at post-treatment (i.e., after 12 weeks) and at a 1 year follow-up. Sixty-two school-based clinicians (37 in CBT; 25 in TAU) and 216 students (148 students in CBT; 68 in TAU) participated. Students were ages 6-18 (mean age 10.87; 64% Caucasian & 29% African American; 48.6% female) and all met DSM-IV diagnostic criteria for a primary anxiety disorder. Independent evaluators (IEs) assessed clinical improvement, global functioning, and loss of anxiety diagnoses; children and parents completed measures of anxiety symptoms. At post-treatment, no significant treatment main effects emerged on the primary outcome; 42% and 37% of youth were classified as treatment responders in CBT and TAU respectively. However, parent-report of child anxiety showed greater improvements in CBT relative to TAU (d = .29). Moderation analyses at post-treatment indicated that older youth, those with social phobia and more severe anxiety at baseline were more likely to be treatment responders in CBT compared to TAU. At the 1 year follow-up, treatment gains were maintained but no treatment group differences or moderators emerged. CBT and TAU for pediatric anxiety disorders, when delivered by school clinicians were generally similar in effectiveness for lowering anxiety and improving functioning at both post-treatment (on all but the parent measure and for specific subgroups) and 1 year follow-up. Implications for disseminating CBT in the school setting are discussed.
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Affiliation(s)
- Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, 65 Kane Street Room 2033, West Hartford, CT, 06119, USA.
| | - Jeffrey E Pella
- Department of Psychiatry, University of Connecticut School of Medicine, 65 Kane Street Room 2033, West Hartford, CT, 06119, USA
| | - Paige J Pikulski
- Department of Psychiatry, University of Connecticut School of Medicine, 65 Kane Street Room 2033, West Hartford, CT, 06119, USA
| | | | - Kelly L Drake
- Anxiety Treatment Center of Maryland, The Johns Hopkins Unviersity School of Medicine Baltimore, Baltimore, MD, 21205, USA
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20
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Makover HB, Kendall PC, Olino T, Carper MM, Albano AM, Piacentini J, Peris T, Langley AK, Gonzalez A, Ginsburg GS, Compton S, Birmaher B, Sakolsky D, Keeton C, Walkup J. Mediators of youth anxiety outcomes 3 to 12 years after treatment. J Anxiety Disord 2020; 70:102188. [PMID: 32078966 PMCID: PMC10783175 DOI: 10.1016/j.janxdis.2020.102188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/13/2019] [Accepted: 01/07/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Test changes in perceived coping efficacy, negative self-statements, and interpretive biases to threat during treatment as potential mediators of the relationship between randomly assigned treatment conditions and long-term anxiety follow-ups. Age at randomization was also tested as a moderator of mediational relationships. METHOD Participants included 319 youth (ages 7-17) from the Child/Adolescent Multimodal Study (CAMS) who participated in a naturalistic follow-up beginning an average of 6.5 years after the end of the CAMS intervention. The intervention conditions included cognitive behavioral therapy (CBT; Coping Cat), pharmacotherapy (sertraline), combined CBT and sertraline, and pill placebo. Putative mediators were measured four times during the intervention phase. Follow-up consisted of four annual assessments of current anxiety. RESULTS Reductions on a measure of interpretive bias to threat over the course of the combined condition intervention, as compared to the placebo condition, mediated anxiety outcomes at the first follow-up visit. This mediated effect was not significant for the CBT-only or sertraline-only conditions when compared to the placebo condition. No other significant mediated effects were found for putative mediators. Age did not significantly moderate any mediated effects. CONCLUSION Changes in youth-reported interpretive biases to threat over the course of combined youth anxiety interventions, as compared to a placebo intervention, may be associated with lower anxiety an average of 6.5 years following treatment.
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Affiliation(s)
- Heather B Makover
- Department of Psychology, Temple University, 1301 North 13th Street, Philadelphia, PA, 19122, USA.
| | - Philip C Kendall
- Department of Psychology, Temple University, 1301 North 13th Street, Philadelphia, PA, 19122, USA.
| | - Thomas Olino
- Department of Psychology, Temple University, 1301 North 13th Street, Philadelphia, PA, 19122, USA
| | - Matthew M Carper
- Department of Psychology, Temple University, 1301 North 13th Street, Philadelphia, PA, 19122, USA
| | - Anne Marie Albano
- Columbia University Clinic for Anxiety and Related Disorders, 1775 Broadway, Suite 601, New York, NY, 10019, USA
| | - John Piacentini
- UCLA Semel Institute, 760 Westwood Blvd, Rm 67-439, Los Angeles, CA, 90024, USA
| | - Tara Peris
- UCLA Semel Institute, 760 Westwood Blvd, Rm 67-439, Los Angeles, CA, 90024, USA
| | - Audra K Langley
- UCLA Semel Institute, 760 Westwood Blvd, Rm 67-439, Los Angeles, CA, 90024, USA
| | - Araceli Gonzalez
- UCLA Semel Institute, 760 Westwood Blvd, Rm 67-439, Los Angeles, CA, 90024, USA
| | - Golda S Ginsburg
- The Johns Hopkins University School of Medicine, Division of Child and Adolescent Psychiatry, 550 North Broadway, Suite 202, Baltimore, MD, 21205, USA
| | - Scott Compton
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3527, Durham, NC, 27710, USA
| | - Boris Birmaher
- University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Dara Sakolsky
- University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Courtney Keeton
- The Johns Hopkins University School of Medicine, Division of Child and Adolescent Psychiatry, 550 North Broadway, Suite 202, Baltimore, MD, 21205, USA
| | - John Walkup
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences at Northwestern University Feinberg School of Medicine, 446 East Ontario, Suite 7-200, Chicago, IL, 60611, USA
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21
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Ginsburg GS, Pella JE, Piselli K, Chan G. Teacher Anxiety Program for Elementary Students (TAPES): intervention development and proposed randomized controlled trial. Trials 2019; 20:792. [PMID: 31888726 PMCID: PMC6937798 DOI: 10.1186/s13063-019-3863-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 10/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background Excessive student anxiety is a common problem that severely impairs short- and long-term academic functioning and increases teacher burden. Reducing student anxiety has been associated with improvement in educational functioning. Because anxiety manifests daily in the classroom, teachers are in an ideal position to identify and help students manage their anxiety. Unfortunately, teachers lack the knowledge and skills to support the learning of students with excessive anxiety. The Teacher Anxiety Program for Elementary Students (TAPES), a novel teacher-administered school-home collaborative intervention, was designed to address this gap. Methods This manuscript describes the protocol for developing and evaluating TAPES. Specifically, we present a description of: (1) the intervention and theoretical model; and (2) methods for the proposed randomized controlled trial comparing TAPES to a standard professional development seminar focused on reducing student anxiety. Discussion Primary aims examine the impact of the TAPES training on teacher knowledge and skill. Secondary aims examine the impact of TAPES on student outcomes. Exploratory aims will examine mediators based on our proposed theory of change. If effective, TAPES has the potential to directly benefit teachers (improving skills) and students (reducing anxiety and improving functioning). Trial registration ClinicalTrials.gov, NCT03899948. Registered on 28 March 2019.
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Affiliation(s)
- Golda S Ginsburg
- University of Connecticut School of Medicine, 65 Kane Street Room 2033, West Hartford, CT, 06119, USA.
| | - Jeffrey E Pella
- University of Connecticut School of Medicine, 65 Kane Street Room 2033, West Hartford, CT, 06119, USA
| | - Kate Piselli
- University of Connecticut School of Medicine, 65 Kane Street Room 2033, West Hartford, CT, 06119, USA
| | - Grace Chan
- University of Connecticut School of Medicine, 65 Kane Street Room 2033, West Hartford, CT, 06119, USA.,University of Connecticut School of Medicine Department of Psychiatry, 263 Farmington Avenue, Farmington, CT, 06030-2103, USA
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22
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Sanchez AL, Comer JS, Coxe S, Albano AM, Piacentini J, Compton SN, Ginsburg GS, Rynn MA, Walkup JT, Sakolsky DJ, Birmaher B, Kendall PC. The Effects of Youth Anxiety Treatment on School Impairment: Differential Outcomes Across CBT, Sertraline, and their Combination. Child Psychiatry Hum Dev 2019; 50:940-949. [PMID: 31087216 DOI: 10.1007/s10578-019-00896-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Youth anxiety disorders are highly prevalent and are associated with considerable school impairment. Despite the identification of well-supported strategies for treating youth anxiety, research has yet to evaluate the differential effects of these treatments on anxiety-related school impairment. The present study leveraged data from the Child/Adolescent Anxiety Multimodal Study to examine differential treatment effects of CBT, sertraline, and their combination (COMB), relative to placebo (PBO), on anxiety-related school impairment among youth (N = 488). Latent growth modeling revealed that all three active treatments demonstrated superiority over PBO in reducing anxiety-related school impairment over time, with COMB showing the most robust effects. According to parent report, medication strategies may have stronger effects on anxiety-related school impairment among males than among females. Results were discrepant across parents and youth. Findings are discussed in terms of clinical implications for anxious youth and the need for continued research to examine treatment effects on anxiety-related school impairment.
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Affiliation(s)
- Amanda L Sanchez
- Center for Children and Families and Department of Psychology, Florida International University, Miami, FL, USA.
| | - Jonathan S Comer
- Center for Children and Families and Department of Psychology, Florida International University, Miami, FL, USA
| | - Stefany Coxe
- Center for Children and Families and Department of Psychology, Florida International University, Miami, FL, USA
| | - Anne Marie Albano
- Division of Child & Adolescent Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, New York, NY, USA
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Scott N Compton
- Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, NC, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Moira A Rynn
- Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, NC, USA
| | - John T Walkup
- Anne and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Dara J Sakolsky
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Boris Birmaher
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
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23
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McGarrah RW, Ferencik M, Giamberardino SN, Coles A, Hoffmann U, Ginsburg GS, Kraus WE, Douglas PS, Shah SH. 170Lipoprotein subclasses associated with high-risk coronary atherosclerotic plaque: insights from the PROMISE clinical trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Greater than half of major adverse cardiovascular events (MACE) occur in individuals with non-obstructive coronary artery disease (CAD) and may be related to the presence of high-risk coronary atherosclerotic plaque (HRP). HRP can be detected by coronary computed tomographic angiography (CTA) and is associated with increased MACE risk. Biomarkers associated with HRP may therefore aid in risk stratification in individuals with chest pain and provide insight into the biology of HRP.
Purpose
To determine whether nuclear magnetic resonance (NMR)-measured lipoprotein particles are associated with HRP independent of risk factors.
Methods
This study included 1755 stable symptomatic outpatients enrolled in the PROMISE trial who had coronary CTA performed. Thirty-seven lipoprotein particle parameters were measured in plasma using NMR. Principal components analysis was used to reduce the number of correlated lipoproteins into a smaller number of uncorrelated factors. HRP cases (N=277) were defined as presence of HRP features (positive remodeling, low CT attenuation or napkin-ring sign) with or without obstructive CAD; controls had no HRP and no obstructive CAD (N=1478). Multivariable logistic regression models adjusting for age, sex, diabetes, hypertension, BMI, smoking status and statin use were used to test for association of lipoprotein factors with HRP case/control status; lipoproteins loaded within significant factors (p<0.05) were tested individually. Finally, because event rates in PROMISE were too low, we used a separate study (CATHGEN, a study of individuals undergoing coronary angiography; N=8707) to test for association of lipoproteins with MACE using multivariable Cox proportional hazard models.
Results
HRP cases were less likely to be female than controls (36.8% vs. 56.6%) and were more likely to have diabetes (23.5% vs 19.6%), but were of similar age (60.1 vs 60.4 years [SD±8]) and with similar statin use (45.2% vs 44.4%). In multivariable models, two lipoprotein factors were associated with HRP: an HDL factor (OR 1.29 [95% CI, 1.10–1.52], p=0.002) and a triglyceride (TG) factor (OR 1.19 [1.03–1.36], p=0.01). Within these two factors, H6P (a large HDL subclass; OR 0.67 [0.54–0.82], p<0.001), HDL size (OR 0.78 [0.66–0.92], p=0.003) and small TG-rich lipoproteins (OR 1.22 [1.07–1.39], p=0.002) were associated with HRP. H6P (HR 1.1 [1.07–1.13], p<0.0001) and HDL size (HR 1.28 [1.24–1.32], p<0.0001) were also associated with time to death or MI in CATHGEN, but in the opposite direction.
Conclusions
In a cohort of low-risk patients from the PROMISE trial, large HDL and small TG particles were associated with CTA-defined HRP independent of risk factors. Large HDL particles were also associated with incident MACE in a separate high-risk cohort. The discordant direction of association of HDL subclasses with HRP and MACE is likely due to underlying HDL biology and requires further study.
Acknowledgement/Funding
The PROMISE trial was funded by the National Heart, Lung, and Blood Institute (grants R01HL098237, R01HL098236, R01HL98305, and R01HL098235)
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Affiliation(s)
- R W McGarrah
- Duke University Medical Center, Durham, United States of America
| | - M Ferencik
- Oregon Health & Science University, Portland, United States of America
| | | | - A Coles
- Duke Clinical Research Institute, Durham, United States of America
| | - U Hoffmann
- Massachusetts General Hospital, Boston, United States of America
| | - G S Ginsburg
- Duke University Medical Center, Durham, United States of America
| | - W E Kraus
- Duke University Medical Center, Durham, United States of America
| | - P S Douglas
- Duke Clinical Research Institute, Durham, United States of America
| | - S H Shah
- Duke University Medical Center, Durham, United States of America
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Keeton CP, Caporino NE, Kendall PC, Iyengar S, Lee P, Peris T, Sakolsky D, Piacentini J, Compton SN, Albano AM, Birmaher B, Ginsburg GS. Mood and suicidality outcomes 3-11 years following pediatric anxiety disorder treatment. Depress Anxiety 2019; 36:930-940. [PMID: 31356713 DOI: 10.1002/da.22944] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 06/06/2019] [Accepted: 06/15/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Youth anxiety interventions have potential to reduce risk for depression and suicidality. METHODS This naturalistic follow-up of the multi-site, comparative treatment trial, inking and behavior, and depressive symptoms 3-11 years (mean 6.25 years) following 12-week evidence-based youth anxiety treatment. Participants (N = 319; 10-26 years, mean 17 years) completed semiannual questionnaires and annual diagnostic interviews for 4 years. RESULTS One-fifth (20.4%) of the sample met DSM-IV criteria for a mood disorder, 32.1% endorsed suicidal ideation, and 8.2% reported suicidal behavior. Latent class growth analysis yielded two linear trajectories of depressive symptoms, and 85% of the sample demonstrated a persistent low-symptom course over seven assessments. Child/Adolescent Anxiety Multimodal Study (CAMS) 12-week treatment outcome (positive response, remission) and treatment condition (cognitive behavior therapy [CBT], medication, CBT + medication, pill placebo) were not associated with subsequent mood disorder or suicidal thinking. CAMS remission predicted absence of suicidal behavior, and treatment response and remission predicted low depressive symptom trajectory. Greater baseline self-reported depressive symptoms predicted all long-term mood outcomes, and more negative life events predicted subsequent mood disorder, depressive symptom trajectory, and suicidal ideation. CONCLUSIONS Effective early treatment of youth anxiety, including CBT, medication, or CBT + medication, reduces risk for subsequent chronic depressive symptoms and suicidal behavior. Attention to (sub)clinical depressive symptoms and management of negative life events may reduce odds of developing a mood disorder, chronic depressive symptoms, and suicidality. Findings contribute to evidence that early intervention for a primary disorder can serve as secondary prevention.
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Affiliation(s)
- Courtney P Keeton
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Phyllis Lee
- Department of Psychological Science, Eastern Connecticut State University, Willimantic, Connecticut
| | - Tara Peris
- Department of Psychiatry, University of California, Los Angeles, California
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburg, Pennsylvania
| | - John Piacentini
- Department of Psychiatry, University of California, Los Angeles, California
| | - Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina.,Department of Psychology & Neuroscience, Duke University, Durham, North Carolina
| | - Anne Marie Albano
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburg, Pennsylvania
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, West Hartford, Connecticut
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Ginsburg GS, Drake KL, Muggeo MA, Stewart CE, Pikulski PJ, Zheng D, Harel O. A pilot RCT of a school nurse delivered intervention to reduce student anxiety. J Clin Child Adolesc Psychol 2019; 50:177-186. [PMID: 31373524 DOI: 10.1080/15374416.2019.1630833] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The goal of this study was to evaluate the feasibility and impact of brief school-nurse-administered interventions for reducing anxiety. Thirty school nurses in Connecticut and Maryland were randomly assigned to deliver the Child Anxiety Learning Modules (CALM; n = 14) or CALM-Relaxation only (CALM-R; n = 16). Students (N = 54) were ages 5-12 (M age = 8; 84.9% White; 68.5% female) with elevated anxiety symptoms and/or anxiety disorders. Feasibility was assessed based on recruitment, retention, attendance, training and intervention satisfaction, and intervention adherence. Multiple informants, including independent evaluators (IEs), completed measures of clinical improvement at postintervention and at a 3-month follow-up. Of nurses in CALM and CALM-R, 62% and 81%, respectively, enrolled a student and completed an average of 6 sessions. Youth retention was 85% and 94% in CALM and CALM-R, respectively. Training and intervention satisfaction were high. At postintervention and follow-up, youth in both groups showed significant reductions in anxiety and related symptoms and improvements in functioning. Within-group effect sizes were medium to large, and between-group effect sizes were small. Task shifting responsibility for delivering brief mental health interventions to school nurses is feasible and shows promise for reducing anxiety and related impairment. This approach may also be integrated within a response to intervention model used in schools.Public Health Significance: Brief school-nurse-administered anxiety reduction interventions were shown to be feasible and had a positive impact on student anxiety and related impairment highlighting that school nurses can be an important school resource.
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Affiliation(s)
- Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine
| | - Kelly L Drake
- The Johns Hopkins University School of Medicine, c/o Anxiety Treatment Center of Maryland
| | - Michela A Muggeo
- Department of Psychiatry, University of Connecticut School of Medicine
| | | | - Paige J Pikulski
- Department of Psychiatry, University of Connecticut School of Medicine
| | - Di Zheng
- Department of Statistics, University of Connecticut
| | - Ofer Harel
- Department of Statistics, University of Connecticut
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26
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Norris LA, Olino TM, Gosch EA, Compton SN, Piacentini J, Ginsburg GS, Albano AM, Walkup JT, Birmaher B, Kendall PC. Person-Centered Profiles Among Treatment-Seeking Children and Adolescents with Anxiety Disorders. J Clin Child Adolesc Psychol 2019; 49:626-638. [PMID: 31039048 DOI: 10.1080/15374416.2019.1602839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Latent profile analysis (LPA) was used to derive homogeneous subgroups within the Child/Adolescent Anxiety Multimodal Study sample (N = 488; 7-17 years, M = 10.69, SD = 2.80) and examine whether class membership predicted or moderated treatment response. Subgroups were identified on baseline multi-informant measures of variables most consistently associated with outcome (youth anxiety/diagnosis, impairment, family psychopathology/functioning). Subgroup membership was examined as a predictor/moderator of outcome across the four treatment conditions (CBT, Sertraline, CBT+Sertraline, pill placebo) at posttreatment (12 weeks) and open-extension follow-up (24 weeks). Four subgroups emerged: mild symptoms/impairment, moderate symptoms/impairment, moderate symptoms/impairment with family dysfunction/parental psychopathology, and severe symptoms/impairment. There were significant between-class differences on socioeconomic status (SES; lower reported SES in the moderate with family dysfunction/parental psychopathology class compared to the mild and moderate class) and age (older age in the severe symptoms class compared to the other three classes). Youth in the mild symptoms/impairment class showed lower posttreatment anxiety across conditions but reported significantly lower symptom severity at baseline. Controlling for demographic differences, response to treatment type did not differ across classes. Analyses indicate that elevated family dysfunction/parental psychopathology clusters primarily within one subgroup of anxious youth rather than mapping onto symptom severity, highlighting the utility of LPA for clarifying within-person combinations of predictor/moderator variables. Implications for development of interventions targeting class-relevant variables are discussed.
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Affiliation(s)
| | | | - Elizabeth A Gosch
- Department of Psychology, Philadelphia College of Osteopathic Medicine
| | - Scott N Compton
- Department of Psychiatry and Behavioral Psychology, Duke University Medical Center
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles School of Medicine
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut Health Center
| | - Anne Marie Albano
- Department of Psychiatry, New York State Psychiatric Institute-Columbia University Medical Center
| | - John T Walkup
- Department of Psychiatry, Weill Cornell Medicine, New York-Presbyterian
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine
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27
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Zehgeer A, Ginsburg GS, Lee P, Birmaher B, Walkup J, Kendall PC, Sakolsky D, Peris T. Pharmacotherapy Adherence for Pediatric Anxiety Disorders: Predictors and Relation to Child Outcomes. Child Youth Care Forum 2018; 47:633-644. [PMID: 30555217 DOI: 10.1007/s10566-018-9459-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background Pharmacotherapy is considered an evidenced-based treatment for anxious youth. There is a need to better understand the relation between medication adherence and child outcomes. Objective This study prospectively examined:1) baseline predictors of adherence and 2) the relation between medication adherence and clinical outcomes in children and adolescents with anxiety disorders. Methods Participants were 349 youth randomized to sertraline, pill placebo, or sertraline plus cognitive behavioral therapy in the Child/Adolescent Anxiety Multimodal Study (CAMS) and followed over 12 weeks. The measure of pharmacotherapy adherence used was pharmacotherapist (PT) ratings of adherence at each session. Four domains of baseline predictors were examined (demographics, child clinical variables, family/parent variables, and treatment variables). Results Multiple regression analyses revealed few significant predictors of adherence. The most robust predictors of greater adherence were living with two parents and parents' positive expectations that medication would lead to better outcomes. Pharmacotherapists' ratings of higher adherence predicted higher global functioning at post treatment and treatment responder status. Conclusions In order to increase adherence, improving expectations and instilling hope for positive outcomes and problem solving ways to overcome pragmatic barriers associated with single parent families is recommended.
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Affiliation(s)
- Asima Zehgeer
- University of Connecticut School of Medicine Department of Psychiatry, Farmington, CT
| | - Golda S Ginsburg
- University of Connecticut School of Medicine Department of Psychiatry, Farmington, CT
| | - Phyllis Lee
- University of Connecticut School of Medicine Department of Psychiatry, Farmington, CT
| | - Boris Birmaher
- University of Pittsburgh Medical Center Department of Psychiatry, Pittsburgh, PA
| | - John Walkup
- Weill Cornell Medical College Department of Psychiatry New York, NY
| | | | - Dara Sakolsky
- University of Pittsburgh Medical Center Department of Psychiatry, Pittsburgh, PA
| | - Tara Peris
- University of California, Los Angeles Department of Psychiatry, Los Angeles, CA
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28
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Jensen-Doss A, Ehrenreich-May J, Nanda MM, Maxwell CA, LoCurto J, Shaw AM, Souer H, Rosenfield D, Ginsburg GS. Community Study of Outcome Monitoring for Emotional Disorders in Teens (COMET): A comparative effectiveness trial of a transdiagnostic treatment and a measurement feedback system. Contemp Clin Trials 2018; 74:18-24. [PMID: 30282056 PMCID: PMC6249684 DOI: 10.1016/j.cct.2018.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 11/29/2022]
Abstract
Emotional disorders, encompassing a range of anxiety and depressive disorders, are the most prevalent and comorbid psychiatric disorders in adolescence. Unfortunately, evidence-based psychosocial therapies typically focus on single disorders, are rarely adopted by community mental health center clinicians, and effect sizes are modest. This article describes the protocol for a comparative effectiveness study of two novel interventions designed to address these challenges. The first intervention is a transdiagnostic treatment (the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents, UP-A), a promising new approach that uses a small number of common strategies to treat a broad range of emotional disorders, and their underlying shared emotional vulnerabilities. The second intervention is a standardized measurement feedback system, the Youth Outcomes Questionnaire (YOQ), designed to improve clinical decision making using weekly symptom and relational data. The three study arms are treatment as usual (TAU), TAU plus the YOQ (TAU+), and UP-A (used in combination with the YOQ). The primary aims of the study are to [1] compare the effects of the UP-A and TAU+ to TAU in community mental health clinics, [2] to isolate the effects of measurement and feedback by comparing the UP-A and TAU+ condition, and [3] to examine the mechanisms of action of both interventions. Design considerations and study methods are provided to inform future effectiveness research.
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Affiliation(s)
- Amanda Jensen-Doss
- University of Miami, Department of Psychology, P.O. Box 248185, Coral Gables, FL 33124-0751, USA.
| | - Jill Ehrenreich-May
- University of Miami, Department of Psychology, P.O. Box 248185, Coral Gables, FL 33124-0751, USA
| | - Monica M Nanda
- University of Miami, Department of Psychology, P.O. Box 248185, Coral Gables, FL 33124-0751, USA
| | - Colleen A Maxwell
- University of Miami, Department of Psychology, P.O. Box 248185, Coral Gables, FL 33124-0751, USA
| | - Jamie LoCurto
- University of Connecticut School of Medicine, 65 Kane Street Room 3022, West Hartford, CT 06119, USA
| | - Ashley M Shaw
- University of Miami, Department of Psychology, P.O. Box 248185, Coral Gables, FL 33124-0751, USA
| | - Heather Souer
- University of Connecticut School of Medicine, 65 Kane Street Room 3022, West Hartford, CT 06119, USA
| | - David Rosenfield
- Southern Methodist University, Department of Psychology, P.O. Box 750442, Dallas, TX 75275, USA
| | - Golda S Ginsburg
- University of Connecticut School of Medicine, 65 Kane Street Room 3022, West Hartford, CT 06119, USA
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29
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Meyersohn NM, Mayrhofer T, Ivanov A, Bittner DO, Staziaki PV, Szilveszter B, Hallett T, Lu ML, Puchner SB, Simon TG, Corey KE, Ginsburg GS, Douglas PS, Hoffmann U, Ferencik M. P6209Association of hepatic steatosis with adverse cardiovascular events: insights from the PROspective Multicenter Imaging Study for Evaluation of chest pain (PROMISE) trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- N M Meyersohn
- Massachusetts General Hospital, Boston, United States of America
| | - T Mayrhofer
- Massachusetts General Hospital, Boston, United States of America
| | - A Ivanov
- Massachusetts General Hospital, Boston, United States of America
| | - D O Bittner
- Massachusetts General Hospital, Boston, United States of America
| | - P V Staziaki
- Massachusetts General Hospital, Boston, United States of America
| | - B Szilveszter
- Massachusetts General Hospital, Boston, United States of America
| | - T Hallett
- Massachusetts General Hospital, Boston, United States of America
| | - M L Lu
- Massachusetts General Hospital, Boston, United States of America
| | - S B Puchner
- Massachusetts General Hospital, Boston, United States of America
| | - T G Simon
- Massachusetts General Hospital, Boston, United States of America
| | - K E Corey
- Massachusetts General Hospital, Boston, United States of America
| | - G S Ginsburg
- Duke University Medical Center, Durham, United States of America
| | - P S Douglas
- Duke University Medical Center, Durham, United States of America
| | - U Hoffmann
- Massachusetts General Hospital, Boston, United States of America
| | - M Ferencik
- Oregon Health & Science University, Portland, United States of America
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30
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Ginsburg GS, Becker-Haimes EM, Keeton C, Kendall PC, Iyengar S, Sakolsky D, Albano AM, Peris T, Compton SN, Piacentini J. Results From the Child/Adolescent Anxiety Multimodal Extended Long-Term Study (CAMELS): Primary Anxiety Outcomes. J Am Acad Child Adolesc Psychiatry 2018; 57:471-480. [PMID: 29960692 DOI: 10.1016/j.jaac.2018.03.017] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/13/2018] [Accepted: 05/03/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To report anxiety outcomes from the multisite Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS). Rates of stable anxiety remission (defined rigorously as the absence of all DSM-IV TR anxiety disorders across all follow-up years) and predictors of anxiety remission across a 4-year period, beginning 4 to 12 years after randomization to 12 weeks of medication, cognitive-behavioral therapy (CBT), their combination, or pill placebo were examined. Examined predictors of remission included acute treatment response, treatment assignment, baseline child and family variables, and interim negative life events. METHOD Data were from 319 youths (age range 10.9-25.2 years; mean age 17.12 years) originally diagnosed with separation, social, and/or generalized anxiety disorders and enrolled in the multi-site Child/Adolescent Anxiety Multimodal Study (CAMS). Participants were assessed annually by independent evaluators using the age-appropriate version of the Anxiety Disorders Interview Schedule and completed questionnaires (eg, about family functioning, life events, and mental health service use). RESULTS Almost 22% of youth were in stable remission, 30% were chronically ill, and 48% were relapsers. Acute treatment responders were less likely to be in the chronically ill group (odds ratio = 2.73; confidence interval = 1.14-6.54; p < .02); treatment type was not associated with remission status across the follow-up. Several variables (eg, male gender) predicted stable remission from anxiety disorders. CONCLUSION Findings suggest that acute positive response to anxiety treatment may reduce risk for chronic anxiety disability; identified predictors can help tailor treatments to youth at greatest risk for chronic illness. CLINICAL TRIAL REGISTRATION INFORMATION Child and Adolescent Anxiety Disorders (CAMS). http://clinicaltrials.gov/; NCT00052078.
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31
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Kiff CJ, Ernestus S, Gonzalez A, Kendall PC, Albano AM, Compton SN, Birmaher B, Ginsburg GS, Rynn M, Walkup JT, McCracken J, Piacentini J. The Interplay of Familial and Individual Risk in Predicting Clinical Improvements in Pediatric Anxiety Disorders. J Clin Child Adolesc Psychol 2018; 47:S542-S554. [PMID: 29877727 DOI: 10.1080/15374416.2018.1460848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Bioecological models of developmental psychopathology underscore the role of familial experiences of adversity and children's individual-level characteristics in heightening risk for pediatric anxiety through direct, combined, and interactive effects. To date, much of the existing research dedicated to pediatric anxiety disorders has largely been examined in bioecological models of diathesis-stress using community samples. This study extends our understanding of children's differential responsiveness to familial adversity by examining the diathesis-stress interaction of cumulative risk and children's individual-level vulnerabilities (negative affectivity and coping efficacy) within a clinic-referred treatment study for pediatric anxiety disorders. A cumulative risk index assessing exposure to familial adversity (e.g., socioeconomic status [SES], parent psychiatric illness) and self-reported measures of children's negative affectivity and coping efficacy were each measured at the intake of a randomized controlled clinical trial for the treatment of pediatric anxiety disorders (N = 488; 7-17 years of age). Trajectories of interviewer-rated anxiety symptoms were assessed across 12 weeks of treatment at baseline, 4 weeks, 8 weeks, and 12 weeks. Consistent with models of temperamental risk for mental health problems, negative affectivity predicted higher anxiety symptoms at intake. A significant diathesis-stress interaction between cumulative risk and coping efficacy emerged, as high risk and perceptions of lower coping efficacy attenuated declines in anxiety across 12 weeks. These patterns did not differ across treatment conditions. The results indicate that for youth experiencing high levels of stress, additional treatment efforts targeting familial stressors and coping efficacy may be important in maximizing treatment outcomes.
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Affiliation(s)
- Cara J Kiff
- a UCLA Semel Institute for Neuroscience and Human Behavior , University of California Los Angeles
| | - Stephanie Ernestus
- a UCLA Semel Institute for Neuroscience and Human Behavior , University of California Los Angeles
| | - Araceli Gonzalez
- b Department of Psychology , California State University , Long Beach
| | | | | | - Scott N Compton
- e Department of Psychiatry and Behavioral Services , Duke University Medical Center
| | - Boris Birmaher
- f Western Psychiatric Institute and Clinics , University of Pittsburgh Medical Center
| | | | - Moira Rynn
- d Department of Psychiatry , Duke University
| | - John T Walkup
- h Department of Child and Adolescent Psychiatry , Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine
| | - James McCracken
- a UCLA Semel Institute for Neuroscience and Human Behavior , University of California Los Angeles
| | - John Piacentini
- a UCLA Semel Institute for Neuroscience and Human Behavior , University of California Los Angeles
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32
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Ginsburg GS, Schleider J, Tein JY, Drake KL. Family and Parent Predictors of Anxiety Disorder Onset in Offspring of Anxious Parents. Child Youth Care Forum 2018; 47:363-376. [PMID: 30034206 PMCID: PMC6051714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Offspring of anxious parents are at increased risk for developing anxiety disorders. There is a need to identify which youth are at greatest risk for disorder onset in this population. OBJECTIVE This study prospectively examined several theory-based family and parent characteristics (e. g., family conflict, parental over-control, parental psychopathology) as predictors of anxiety disorder onset in children whose parents were clinically anxious. METHODS Families were enrolled in a randomized controlled trial evaluating a familybased preventative intervention, relative to an information monitoring control condition, for offspring of anxious parents (N= 136; child mean age 8.69 years; 55% female; 85% Caucasian). Family and parent measures were collected using multiple informants and an observational task at baseline, post-intervention, and at a six and 12 month followup. Child anxiety disorder diagnosis was determined by independent evaluators using the Anxiety Disorders Interview Schedule for Children. RESULTS Results indicated that none of the baseline family or parent variables examined predicted the onset of an anxiety disorder in children over the one year follow-up period. CONCLUSIONS Findings raise questions about the short-term risk associated with family and parent factors in anxiety disorder development in this high risk population.
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Affiliation(s)
- Golda S. Ginsburg
- University of Connecticut School of Medicine, Department of Psychiatry, Farmington, CT
| | | | - Jenn Yun Tein
- Arizona State University, Department of Psychology, Tempe, AZ
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Abstract
Pediatric anxiety disorders are common, disabling, and chronic conditions. Efforts over the past two decades have focused on developing and testing effective treatments. Short-term efficacy of both Cognitive Behavioral Therapy (CBT) and selective serotonin reuptake inhibitors has been established. Data are emerging on the long-term (i.e., 2 years or longer) effectiveness of these treatments, but this literature has yet to be adequately synthesized. This study presents a systematic and critical qualitative review of published long-term follow-up (LTFU) studies of youth treated for an anxiety disorder. A comprehensive search of several databases identified 21 published reports (representing 15 LTFU cohorts of treated youth) meeting specified inclusion criteria. LTFU assessments occurred a mean of 5.85 years after initial treatment (range 2-19 years). Diagnostic rates at LTFU and predictors (e.g., demographic, baseline child clinical variables, treatment type) of outcomes at LTFU were also examined. A discussion of the limitations of this literature is provided to qualify interpretations of findings and to inform future studies. Findings can aid clinicians and families in making treatment decisions and setting reasonable expectations for the long-term prognosis after treatment for anxiety.
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Affiliation(s)
- Brittany A Gibby
- Florida State University, 1107 West Call Street, Tallahassee, FL, 32303, USA
| | - Elizabeth P Casline
- University of Connecticut Health, 65 Kane Street, West Hartford, CT, 06119, USA
| | - Golda S Ginsburg
- University of Connecticut Health, 65 Kane Street, West Hartford, CT, 06119, USA.
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34
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Abstract
Anxiety disorders are common in youth. Because somatic complaints are a hallmark feature of anxiety, these students frequently visit their school nurse, creating an ideal opportunity for nurses to identify and assist them. In an effort to better understand current practices, we surveyed a large sample ( N = 93) of school nurses. Results indicated that the majority of nurses perceived anxiety as the most prevalent mental health issue in their students. Moreover, the majority of nurses reported that they did not use any formal screening tool or intervention protocol and stated wanting to expand their training in anxiety intervention. These data suggest that school nurses identify anxiety as a top problem but do not receive adequate training to address it. Data from this survey may be used to plan how best to fill gaps in nurse training and practices that can enhance nurses' capacity to optimize outcomes for anxious students.
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Affiliation(s)
- Michela A Muggeo
- 1 Department of Psychiatry, University of Connecticut School of Medicine, West Hartford, CT, USA
| | - Golda S Ginsburg
- 1 Department of Psychiatry, University of Connecticut School of Medicine, West Hartford, CT, USA
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35
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Abstract
Greater parent-youth disagreement on youth symptomatology is associated with a host of factors (e.g., parental psychopathology, family functioning) that might impede treatment. Parent-youth disagreement may represent an indicator of treatment prognosis. Using data from the Child/Adolescent Anxiety Multimodal Study, this study used polynomial regression and longitudinal growth modeling to examine whether parent-youth agreement prior to and throughout treatment predicted treatment outcomes (anxiety severity, youth functioning, responder status, and diagnostic remission, rated by an independent evaluator). When parents reported more symptoms than youth prior to treatment, youth were less likely to be diagnosis-free post-treatment; this was only true if the youth received cognitive-behavioral therapy (CBT) alone, not if youth received medication, combination, or placebo treatment. Increasing concordance between parents and youth over the course of treatment was associated with better treatment outcomes across all outcome measures ( ps < .001). How parents and youth "co-report" appears to be an indicator of CBT outcome. Clinical implications and future directions are discussed.
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Affiliation(s)
- Emily M Becker-Haimes
- Department of Psychology, University of Miami, USA
- Perelman School of Medicine, University of Pennsylvania, USA
| | | | - Boris Birmaher
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, USA
| | | | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut Health Center, USA
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Hale AE, Ginsburg GS, Chan G, Kendall PC, McCracken J, Sakolsky D, Birmaher B, Compton S, Marie Albano A, Walkup J. Mediators of Treatment Outcomes for Anxious Children and Adolescents: The Role of Somatic Symptoms. J Clin Child Adolesc Psychol 2018; 47:94-104. [PMID: 28278599 PMCID: PMC6129169 DOI: 10.1080/15374416.2017.1280804] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors are effective treatments for pediatric anxiety disorders. However, the mechanisms of these treatments are unknown. Previous research indicated that somatic symptoms are reduced following treatment, but it is unclear if their reductions are merely a consequence of treatment gains. This study examined reductions in somatic symptoms as a potential mediator of the relationship between treatment and anxiety outcomes. Participants were 488 anxious youth ages 7-17 (M = 10.7), 50.4% male, 78.9% Caucasian, enrolled in Child/Adolescent Anxiety Multimodal Study, a large randomized control trial comparing 12-week treatments of CBT, sertraline, a combination of CBT and sertraline, and a pill placebo. Causal mediation models were tested in R using data from baseline, 8-, and 12-week evaluations. Somatic symptoms were assessed using the Panic/Somatic subscale from the Screen for Child Anxiety Related Emotional Disorders. Youth outcomes were assessed using the Pediatric Anxiety Rating Scale and Children's Global Assessment Scale. Reductions in somatic symptoms mediated improvement in anxiety symptoms and global functioning for those in the sertraline-only condition based on parent report. Conditions involving CBT and data based on child reported somatic symptoms did not show a mediation effect. Findings indicate that reductions in somatic symptoms may be a mediator of improvements for treatments including pharmacotherapy and not CBT. Although the overall efficacy of sertraline and CBT for anxiety may be similar, the treatments appear to function via different mechanisms.
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Affiliation(s)
- Amy E. Hale
- University of Connecticut Health Center, 65 Kane St, West Hartford, CT 06119
| | - Golda S. Ginsburg
- University of Connecticut Health Center, 65 Kane St, West Hartford, CT 06119
| | - Grace Chan
- University of Connecticut Health Center, 65 Kane St, West Hartford, CT 06119
| | | | - James McCracken
- UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, CA
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Albano AM, Comer JS, Compton SN, Piacentini J, Kendall PC, Birmaher B, Walkup JT, Ginsburg GS, Rynn MA, McCracken J, Keeton C, Sakolsky DJ, Sherrill JT. Secondary Outcomes From the Child/Adolescent Anxiety Multimodal Study: Implications for Clinical Practice. ACTA ACUST UNITED AC 2017; 3:30-41. [PMID: 30906874 DOI: 10.1080/23794925.2017.1399485] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Controlled evaluations comparing medication, cognitive-behavioral therapy (CBT), and their combination in the treatment of youth anxiety have predominantly focused on global ratings by independent evaluators. Such ratings are resource-intensive, may be of limited generalizability, and do not directly inform our understanding of treatment responses from the perspective of treated families. We examined outcomes from the perspective of treated youth and parents in the Child/Adolescent Anxiety Multimodal Study (CAMS). Methods Participants (N=488; ages 7-17 years) who had a primary diagnosis of separation, social, and/or generalized anxiety disorder were randomly assigned to a treatment condition in the CAMS trial. Linear mixed-effects and ANCOVA models examined parent- and youth-reported anxiety symptoms, impact of anxiety, broader internalizing and externalizing psychopathology, depressive symptoms, and family burden throughout the 12-week acute treatment phase and 6-month follow-up. Results At week 12, combination treatment showed superiority over placebo, sertraline, and CBT with regard to parent-reported youth anxiety symptoms, and sertraline and CBT as monotherapies showed superiority over placebo with regard to parent-reported youth anxiety. Combination therapy and sertraline also showed week 12 superiority over placebo with regard to parent-reported internalizing psychopathology, and superiority over placebo and CBT with regard to parent-reported impact of anxiety, family burden, and youth depressive symptoms. By week 36, parent reports of many youth outcomes were comparable across active conditions. Youth measures tracked parent measures on many outcomes. Conclusions Findings were drawn on brief, readily available questionnaires that in conjunction with clinician measures can inform patient-centered care and collaborative decision-making.Trial Registry Name: Child and Adolescent Anxiety Disorders (CAMS)Registry identification number: NCT00052078Registry URL: https://www.clinicaltrials.gov/ct2/show/NCT00052078.
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Affiliation(s)
- Anne Marie Albano
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Medical Center, New York, NY
| | - Jonathan S Comer
- Departments of Psychology and Psychiatry, Center for Children and Families, Florida International University, Miami, FL
| | - Scott N Compton
- Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, North Carolina
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | | | - Boris Birmaher
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center, Pittsburgh, PA
| | - John T Walkup
- Department of Psychiatry, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT
| | - Moira A Rynn
- Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, North Carolina
| | - James McCracken
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Courtney Keeton
- Department of Psychiatry, Johns Hopkins Medical Institutions
| | - Dara J Sakolsky
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Joel T Sherrill
- Division of Services and Interventions Research, National Institute of Mental Health, Bethesda, MD
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Strawn JR, Dobson ET, Mills JA, Cornwall GJ, Sakolsky D, Birmaher B, Compton SN, Piacentini J, McCracken JT, Ginsburg GS, Kendall PC, Walkup JT, Albano AM, Rynn MA. Placebo Response in Pediatric Anxiety Disorders: Results from the Child/Adolescent Anxiety Multimodal Study. J Child Adolesc Psychopharmacol 2017; 27:501-508. [PMID: 28384010 PMCID: PMC5568015 DOI: 10.1089/cap.2016.0198] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study is to identify predictors of pill placebo response and to characterize the temporal course of pill placebo response in anxious youth. METHODS Data from placebo-treated patients (N = 76) in the Child/Adolescent Anxiety Multimodal Study (CAMS), a multisite, randomized controlled trial that examined the efficacy of cognitive-behavioral therapy, sertraline, their combination, and placebo for the treatment of separation, generalized, and social anxiety disorders, were evaluated. Multiple linear regression models identified features associated with placebo response and models were confirmed with leave-one-out cross-validation. The likelihood of improvement in patients receiving pill placebo-over time-relative to improvement associated with active treatment was determined using probabilistic Bayesian analyses. RESULTS Based on a categorical definition of response (Clinical Global Impressions-Improvement Scale score ≤2), nonresponders (n = 48), and pill placebo responders (n = 18) did not differ in age (p = 0.217), sex (p = 0.980), race (p = 0.743), or primary diagnosis (all ps > 0.659). In terms of change in anxiety symptoms, separation anxiety disorder and treatment expectation were associated with the degree of pill placebo response. Greater probability of placebo-related anxiety symptom improvement was observed early in the course of treatment (baseline to week 4, p < 0.0001). No significant change in the probability of placebo-related improvement was observed after week 4 (weeks 4-8, p = 0.07; weeks 8-12, p = 0.85), whereas the probability of improvement, in general, significantly increased week over week with active treatment. CONCLUSIONS Pill placebo-related improvement occurs early in the course of treatment and both clinical factors and expectation predict this improvement. Additionally, probabilistic approaches may refine our understanding and prediction of pill placebo response.
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Affiliation(s)
- Jeffrey R. Strawn
- Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Division of Child and Adolescent Psychiatry, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Eric T. Dobson
- Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jeffrey A. Mills
- Carl H. Lindner College of Business, University of Cincinnati, Cincinnati, Ohio
| | - Gary J. Cornwall
- Carl H. Lindner College of Business, University of Cincinnati, Cincinnati, Ohio
| | - Dara Sakolsky
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Boris Birmaher
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, California
| | - James T. McCracken
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, California
| | | | | | - John T. Walkup
- Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
| | - Anne Marie Albano
- Columbia University Medical Center (CUMC)/New York State Psychiatric Institute, New York, New York
| | - Moira A. Rynn
- Columbia University Medical Center (CUMC)/New York State Psychiatric Institute, New York, New York
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39
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Lee P, Zehgeer A, Ginsburg GS, McCracken J, Keeton C, Kendall PC, Birmaher B, Sakolsky D, Walkup J, Peris T, Albano AM, Compton S. Child and Adolescent Adherence With Cognitive Behavioral Therapy for Anxiety: Predictors and Associations With Outcomes. J Clin Child Adolesc Psychol 2017; 48:S215-S226. [PMID: 28448176 DOI: 10.1080/15374416.2017.1310046] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cognitive behavioral therapy (CBT) for anxiety disorders is effective, but nonadherence with treatment may reduce the benefits of CBT. This study examined (a) four baseline domains (i.e., demographic, youth clinical characteristics, therapy related, family/parent factors) as predictors of youth adherence with treatment and (b) the associations between youth adherence and treatment outcomes. Data were from 279 youth (7-17 years of age, 51.6% female; 79.6% White, 9% African American), with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) diagnoses of separation anxiety disorder, generalized anxiety disorder, and/or social phobia, who participated in CBT in the Child/Adolescent Anxiety Multimodal Study. Adherence was defined in three ways (session attendance, therapist-rated compliance, and homework completion). Multiple regressions revealed several significant predictors of youth adherence with CBT, but predictors varied according to the definition of adherence. The most robust predictors of greater adherence were living with both parents and fewer youth comorbid externalizing disorders. With respect to outcomes, therapist ratings of higher youth compliance with CBT predicted several indices of favorable outcome: lower anxiety severity, higher global functioning, and treatment responder status after 12 weeks of CBT. Number of sessions attended and homework completion did not predict treatment outcomes. Findings provide information about risks for youth nonadherence, which can inform treatment and highlight the importance of youth compliance with participating in therapy activities, rather than just attending sessions or completing homework assignments.
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Affiliation(s)
- Phyllis Lee
- a Department of Psychiatry, University of Connecticut Health
| | - Asima Zehgeer
- a Department of Psychiatry, University of Connecticut Health
| | | | - James McCracken
- b Division of Child and Adolescent Psychiatry,UCLA Semel Institute of Neuroscience and Human Behavior
| | - Courtney Keeton
- c Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine
| | | | | | - Dara Sakolsky
- e Department of Psychiatry, University of Pittsburgh
| | - John Walkup
- f Department of Child and Adolescent Psychiatry, Weill Cornell Medical College
| | - Tara Peris
- b Division of Child and Adolescent Psychiatry,UCLA Semel Institute of Neuroscience and Human Behavior
| | - Anne Marie Albano
- g Department of Child and Adolescent Psychiatry, Columbia University
| | - Scott Compton
- h Department of Psychiatry and Behavioral Sciences, Duke University
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40
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Schleider JL, Ginsburg GS, Drake K. Perceived Peer Victimization Predicts Anxiety Outcomes in a Prevention Program for Offspring of Anxious Parents. J Clin Child Adolesc Psychol 2017; 47:S255-S263. [PMID: 28145769 PMCID: PMC6237653 DOI: 10.1080/15374416.2016.1270831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Offspring of anxious parents are at heightened risk for developing anxiety disorders. Preventive interventions for these youths are promising but not universally effective, creating a need to identify outcome predictors. Peer experiences (e.g., peer victimization, social support) are associated with youth anxiety trajectories but have been relatively unexplored in this context. Thus, this study tested whether peer experiences predicted anxiety-related outcomes in families participating in a randomized controlled trial of a child anxiety prevention program for families with a clinically anxious parent. Parental anxiety severity was also examined as a moderator of relations between peer experiences and subsequent child anxiety. Participants were 121 families (child M age = 8.69, 55.90% girls). Hierarchical logistic and linear regressions were used to test whether baseline peer-related factors predicted increased anxiety symptom severity and anxiety disorder onset over 12 months. Youths reporting greater perceived peer victimization at baseline were more likely to develop an anxiety disorder and had more severe anxiety symptoms 12 months later. Lower social support from classmates also predicted increased anxiety severity, but this effect became nonsignificant after accounting for peer victimization. Further, parental anxiety severity moderated the peer victimization-child anxiety severity link: Higher child-reported peer victimization predicted increased anxiety in offspring of highly and moderately anxious but not low anxious parents. Children's reports of peer victimization appear important for understanding which youth may not respond to preventive interventions in high-risk families-especially for children with more severely anxious parents. Implications for the focus of selective anxiety prevention programs are discussed.
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Affiliation(s)
- Jessica L. Schleider
- Department of Psychology, Harvard University, 33 Kirkland St Will James Hall, Cambridge, MA 02138
| | - Golda S. Ginsburg
- Department of Psychiatry, University of Connecticut Health, 65 Kane St, West Hartford, CT 06117
| | - Kelly Drake
- Anxiety Treatment Center of Maryland, Ellicott City, MD
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41
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Affiliation(s)
- E T Cirulli
- Duke Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, USA
| | - G S Ginsburg
- Duke Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, USA
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42
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Abstract
Somatic symptoms are an associated feature of anxiety disorders that have received little research attention among non-White samples. In addition, the majority of previous studies have examined the influence of somatic symptoms in a cross-sectional rather than a prospective manner. This study examines the prevalence of 12 somatic symptoms, the association of somatic and anxiety symptoms (both concurrently and prospectively) with psychosocial functioning, and gender differences in somatic symptoms among a community sample of 114 African American adolescents (57 girls). In all, 83% of the sample reported at least one somatic symptom (some or most of the time within the past 2 weeks), and on average, adolescents reported 2.5 somatic symptoms. Somatic symptoms correlated positively with severity of anxiety symptoms and negatively with aspects of perceived competence. After the initial level of anxiety symptoms was controlled for, somatic symptoms were a unique predictor of perceived competence (at initial assessment) and anxiety symptoms (at 6-month follow-up). Overall, girls endorsed significantly more somatic symptoms than did boys. Findings replicate those of studies with White samples and suggest that somatic symptoms may be a risk factor for anxiety disorders among African American youth.
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43
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Becker EM, Jensen-Doss A, Kendall PC, Birmaher B, Ginsburg GS. All anxiety is not created equal: Correlates of parent/youth agreement vary across subtypes of anxiety. J Psychopathol Behav Assess 2016; 38:528-537. [PMID: 28408785 DOI: 10.1007/s10862-016-9544-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Research has examined patterns and correlates of parent/youth informant discrepancies in the reporting of youth anxiety. However, little work has examined whether it is better to conceptualize patterns and correlates of informant disagreement across anxiety broadly, or more useful to consider disagreement on specific symptom clusters. Using data from the Child Adolescent/Anxiety Multimodal Study (CAMS; N = 488; Walkup et al., 2008), the current study applied the most recent recommended analytic strategies to study informant discrepancies and examined differences in the magnitude and patterns of disagreement for: (a) broadband anxiety symptoms, versus (b) symptoms of specific anxiety diagnoses (or anxiety subtypes; e.g., separation, social anxiety). Correlates of informant discrepancies were also examined. Results indicated that there was variability in agreement across anxiety subtypes, with parent/youth agreement higher on separation anxiety and school refusal symptoms relative to other domains. Parental psychopathology was associated with disagreement on broadband anxiety symptoms, such that parental psychopathology was highest when parents reported higher symptoms than their children; however, this finding was largely driven by a relationship between parental psychopathology and disagreement on separation anxiety symptoms. Age was associated with disagreement on total and separation anxiety symptoms. Gender was not associated with disagreement. Clinical implications are discussed.
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Affiliation(s)
- Emily M Becker
- University of Miami Department of Psychology, Coral Gables, FL
| | | | | | - Boris Birmaher
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut Health Center, West Hartford, CT
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McClain MT, Henao R, Williams J, Nicholson B, Veldman T, Hudson L, Tsalik EL, Lambkin-Williams R, Gilbert A, Mann A, Ginsburg GS, Woods CW. Differential evolution of peripheral cytokine levels in symptomatic and asymptomatic responses to experimental influenza virus challenge. Clin Exp Immunol 2015; 183:441-51. [PMID: 26506932 DOI: 10.1111/cei.12736] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 10/04/2015] [Accepted: 10/13/2015] [Indexed: 02/02/2023] Open
Abstract
Exposure to influenza virus triggers a complex cascade of events in the human host. In order to understand more clearly the evolution of this intricate response over time, human volunteers were inoculated with influenza A/Wisconsin/67/2005 (H3N2), and then had serial peripheral blood samples drawn and tested for the presence of 25 major human cytokines. Nine of 17 (53%) inoculated subjects developed symptomatic influenza infection. Individuals who will go on to become symptomatic demonstrate increased circulating levels of interleukin (IL)-6, IL-8, IL-15, monocyte chemotactic protein (MCP)-1 and interferon (IFN) gamma-induced protein (IP)-10 as early as 12-29 h post-inoculation (during the presymptomatic phase), whereas challenged patients who remain asymptomatic do not. Overall, the immunological pathways of leucocyte recruitment, Toll-like receptor (TLR)-signalling, innate anti-viral immunity and fever production are all over-represented in symptomatic individuals very early in disease, but are also dynamic and evolve continuously over time. Comparison with simultaneous peripheral blood genomics demonstrates that some inflammatory mediators (MCP-1, IP-10, IL-15) are being expressed actively in circulating cells, while others (IL-6, IL-8, IFN-α and IFN-γ) are probable effectors produced locally at the site of infection. Interestingly, asymptomatic exposed subjects are not quiescent either immunologically or genomically, but instead exhibit early and persistent down-regulation of important inflammatory mediators in the periphery. The host inflammatory response to influenza infection is variable but robust, and evolves over time. These results offer critical insight into pathways driving influenza-related symptomatology and offer the potential to contribute to early detection and differentiation of infected hosts.
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Affiliation(s)
- M T McClain
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA.,Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - R Henao
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA.,Department of Electrical Engineering, Duke University, Durham, NC, USA
| | - J Williams
- Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - B Nicholson
- Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - T Veldman
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA
| | - L Hudson
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA
| | - E L Tsalik
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA.,Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | | | | | | | - G S Ginsburg
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA
| | - C W Woods
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA.,Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
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45
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Ginsburg GS, Drake KL, Tein JY, Teetsel R, Riddle MA. Preventing Onset of Anxiety Disorders in Offspring of Anxious Parents: A Randomized Controlled Trial of a Family-Based Intervention. Am J Psychiatry 2015; 172:1207-14. [PMID: 26404420 PMCID: PMC6013063 DOI: 10.1176/appi.ajp.2015.14091178] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the efficacy of a family-based intervention to prevent the onset of anxiety disorders in offspring of anxious parents. METHOD Participants were 136 families with a parent meeting DSM-IV criteria for an anxiety disorder and one child 6-13 years of age without an anxiety disorder. Families were randomly assigned to the family-based intervention (N=70) or to an information-monitoring control condition (N=66). All families were expected to complete assessments, administered by blind interviewers, at baseline, at the end of the intervention (or 8 weeks after randomization) and at 6- and 12-month follow-ups. Onset of any anxiety disorder and anxiety symptom severity (assessed using the Anxiety Disorders Interview Schedule for Children) at 12 months were the primary and secondary outcome measures, respectively. RESULTS The incidence of child anxiety disorders was 31% in the control group and 5% in the intervention group (odds ratio=8.54, 95% CI=2.27, 32.06). At the 1-year follow-up, youths in the control group also had higher anxiety symptoms ratings than those in the intervention group. Effect sizes were medium to large (0.81 at 6 months and 0.57 at 12 months for anxiety symptoms), and the number needed to treat was 3.9 at 12 months. Significant moderators included baseline levels of child anxiety; significant mediators were parental distress and modeling of anxiety. Child maladaptive cognitions and parental anxiety did not mediate outcomes. CONCLUSIONS A brief psychosocial prevention program holds promise for reducing the 1-year incidence of anxiety disorders among offspring of anxious parents.
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Keeton CP, Teetsel RN, Dull NMS, Ginsburg GS. Parent Psychopathology and Children's Psychological Health: Moderation by Sibling Relationship Dimensions. J Abnorm Child Psychol 2015; 43:1333-42. [PMID: 25896728 PMCID: PMC6013740 DOI: 10.1007/s10802-015-0013-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Offspring of anxious adults are at heightened risk for psychological maladjustment; however factors that protect youth in the context of this risk have been rarely explored. Supported by literature showing the meaningful role of sibling relationships for children's psychological outcomes, this study examined the protective role of the sibling relationship for children in the context of risk for psychological maladjustment due to having a parent with a clinical anxiety disorder. Participants were 81 children ages 7 to 12 years (58% female; 82 % Caucasian), and their parents. Parents met DSM-IV-TR diagnostic criteria for a primary anxiety disorder, and youth did not meet diagnostic criteria for any psychiatric disorder. Parents completed questionnaires on their own psychological distress and use of parenting behaviors, and on their children's psychological adjustment. Children self-reported on the quality of their sibling relationship based on their closest-age sibling. Parenting behaviors were also coded based on a parent-child interaction task. Results of hierarchical regression models demonstrated that sibling relationship quality moderated the relation between parental psychological distress and child adjustment. Post-hoc simple slopes analyses showed that parental distress was significantly positively associated with greater child psychological problems only for children reporting low sibling companionship or high sibling conflict. Aspects of the sibling relationship did not moderate the association between self-rated or observer-rated parenting behaviors and child anxiety symptoms. Findings are consistent with developmental models and empirical literature emphasizing the protective role of sibling relationships for youth's psychological outcomes. Sibling relationships may be a salient target for youth psychological preventive or treatment interventions.
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Affiliation(s)
- Courtney P Keeton
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA,
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47
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Gordon-Hollingsworth AT, Becker EM, Ginsburg GS, Keeton C, Compton SN, Birmaher BB, Sakolsky DJ, Piacentini J, Albano AM, Kendall PC, Suveg CM, March JS. Anxiety Disorders in Caucasian and African American Children: A Comparison of Clinical Characteristics, Treatment Process Variables, and Treatment Outcomes. Child Psychiatry Hum Dev 2015; 46:643-55. [PMID: 25293650 PMCID: PMC4390415 DOI: 10.1007/s10578-014-0507-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examined racial differences in anxious youth using data from the Child/Adolescent Anxiety Multimodal Study (CAMS) [1]. Specifically, the study aims addressed whether African American (n = 44) versus Caucasian (n = 359) children varied on (1) baseline clinical characteristics, (2) treatment process variables, and (3) treatment outcomes. Participants were ages 7-17 and met DSM-IV-TR criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder. Baseline data, as well as outcome data at 12 and 24 weeks, were obtained by independent evaluators. Weekly treatment process variables were collected by therapists. Results indicated no racial differences on baseline clinical characteristics. However, African American participants attended fewer psychotherapy and pharmacotherapy sessions, and were rated by therapists as less involved and compliant, in addition to showing lower mastery of CBT. Once these and other demographic factors were accounted for, race was not a significant predictor of response, remission, or relapse. Implications of these findings suggest African American and Caucasian youth are more similar than different with respect to the manifestations of anxiety and differences in outcomes are likely due to treatment barriers to session attendance and therapist engagement.
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Affiliation(s)
- Arlene T. Gordon-Hollingsworth
- Department of Pediatrics, Psychology Section, Baylor College of Medicine, 6701 Fannin Street, CC1630, Houston, TX 77030, USA
- Division of Child and Adolescent Psychiatry, The Johns Hopkins University School of Medicine, 550 N. Broadway, Baltimore, MD 21205, USA
| | - Emily M. Becker
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL 33124-0751, USA
| | - Golda S. Ginsburg
- Department of Psychiatry, University of Connecticut Health Center, 65 Kane Street, Room 1005, West Hartford, CT 06119, USA
| | - Courtney Keeton
- Division of Child and Adolescent Psychiatry, The Johns Hopkins University School of Medicine, 550 N. Broadway, Baltimore, MD 21205, USA
| | - Scott N. Compton
- Department of Psychiatry, Duke University Medical Center, Suite 3527, Durham, NC 27710, USA
| | - Boris B. Birmaher
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburg, PA 15213, USA
- Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburg, PA, USA
| | - Dara J. Sakolsky
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburg, PA 15213, USA
- Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburg, PA, USA
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Anne M. Albano
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - Philip C. Kendall
- Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 19122, USA
| | - Cynthia M. Suveg
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA 30602, USA
| | - John S. March
- Division of Neurosciences Medicine, Duke Research Institute, 2400 Pratt Street, Durham, NC 27710, USA
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48
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Drake KL, Stewart CE, Muggeo MA, Ginsburg GS. Enhancing the Capacity of School Nurses to Reduce Excessive Anxiety in Children: Development of the CALM Intervention. J Child Adolesc Psychiatr Nurs 2015; 28:121-30. [PMID: 26171792 PMCID: PMC6013739 DOI: 10.1111/jcap.12115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PROBLEM Excessive anxiety is among the most common psychiatric problems facing youth. Because anxious youth tend to have somatic complaints, many seek help from the school nurse. Thus, school nurses are in an ideal position to provide early intervention. This study addresses this problem and describes the plans to develop and test a new intervention (Child Anxiety Learning Modules; CALM), delivered by school nurses, to reduce child anxiety and improve academic functioning. METHODS An iterative development process including consultation with an expert panel, two open trials, and a pilot randomized controlled study comparing CALM to usual care is proposed. Feedback will be solicited from all participants during each phase and data on outcome measures will be provided by children, parents, teachers, and independent evaluators. FINDINGS Data will be collected on intervention satisfaction and feasibility. Primary outcomes that include child anxiety symptoms, classroom behavior, and school performance (e.g., attendance, grades, standardized test scores) will be collected at pre- and post-interventions and at a 3-month follow-up evaluation. CONCLUSIONS Pediatric anxiety is a common problem that school nurses frequently encounter. Consequently, they are well positioned to play a key role in enhancing access to behavioral health interventions to reduce anxiety and may therefore make a significant positive public health impact.
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Affiliation(s)
- Kelly L Drake
- The Johns Hopkins University School of Medicine, c/o Anxiety Treatment Center of Maryland, Ellicott City, MD, USA
| | | | - Michela A Muggeo
- Department of Psychiatry, University of Connecticut Health Center, West Hartford, CT, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut Health Center, West Hartford, CT, USA
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White SW, Lerner MD, McLeod BD, Wood JJ, Ginsburg GS, Kerns C, Ollendick T, Kendall PC, Piacentini J, Walkup J, Compton S. Anxiety in youth with and without autism spectrum disorder: examination of factorial equivalence. Behav Ther 2015; 46:40-53. [PMID: 25526834 PMCID: PMC4273846 DOI: 10.1016/j.beth.2014.05.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 05/21/2014] [Accepted: 05/22/2014] [Indexed: 12/28/2022]
Abstract
Although anxiety is frequently reported among children and adolescents with autism spectrum disorder (ASD), it has not been established that the manifest symptoms of anxiety in the context of ASD are the same as those seen in youth without ASD. This study sought to examine the metric and latent factor equivalence of anxiety as measured by the Multidimensional Anxiety Scale for Children, parent-report (MASC-P) and child-report (MASC-C), in youth with anxiety disorders and ASD with intact verbal ability (n=109, M(age)=11.67 years, 99 male) and a gender-matched comparison group of typically developing (TD) children and adolescents with anxiety disorders but without ASD (n=342, M(age)=11.25 years, 246 male). Multigroup factorial invariance (MFI) using structural equation modeling indicated equivalent latent factors in youth with and without ASD on the MASC-C (metric invariance). However, the item means and covariances along with the relations among the factor scores were different for the youth with ASD (i.e., lack of evidence for scalar or structural invariance). The MASC-P data did not fit the measure's established structure for either the ASD or TD group, and post-hoc exploratory factor analysis revealed a different factor structure in the ASD group. Findings suggest that the MASC-C may not measure identical constructs in anxious youth with and without ASD. Further research on the structure of the MASC in clinical samples is warranted.
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50
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Nail JE, Christofferson J, Ginsburg GS, Drake K, Kendall PC, McCracken JT, Birmaher B, Walkup JT, Compton SN, Keeton C, Sakolsky D. Academic Impairment and Impact of Treatments Among Youth with Anxiety Disorders. Child Youth Care Forum 2014. [DOI: 10.1007/s10566-014-9290-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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