New research
A Longitudinal Follow-up Study Examining Adolescent Depressive Symptoms as a Function of Prior Anxiety Treatment

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Objective

Children who are fearful and anxious are at heightened risk for developing depression in adolescence. Treating anxiety disorders in pre-/early adolescence may be one mechanism through which depressive symptoms later in adolescence can be prevented. We hypothesized that anxious youth who responded positively to cognitive-behavioral therapy (CBT) for anxiety would show reduced onset of depressive symptoms 2 years later compared to treatment nonresponders, and that this effect would be specific to youth treated with CBT compared to an active supportive comparison treatment.

Method

Participants were 80 adolescents ages 11 to 17 years who had previously completed a randomized trial comparing predictors of treatment response to CBT and child-centered therapy (CCT). Youth met DSM-IV criteria for generalized, separation, and/or social anxiety disorder at the time of treatment. The present study was a prospective naturalistic 2-year follow-up examining trajectories toward depression, in which participants were reassessed for depressive symptoms 2 years after anxiety treatment. Treatment response was defined as a 35% reduction in independent evaluator−rated anxiety severity on the Pediatric Anxiety Rating Scale after treatment.

Results

As hypothesized, lower levels of depressive symptoms were observed in anxious youth who responded to CBT for anxiety (β = −0.807, p = .004) but not CCT (β = 0.254, p = .505). Sensitivity analyses showed that the effects were driven by girls.

Conclusion

Findings suggest that CBT for anxiety is a promising approach to preventing adolescent depressive symptomatology, especially among girls. The results highlight the need for better early screening for anxiety and better dissemination of CBT programs targeting anxiety in youth.

Section snippets

Adolescence as a Period of Risk for Depression

The transition into adolescence may represent a sensitive period for the development and prevention of depressive symptoms. The transitional period between preadolescence and early adolescence, beginning with the onset of pubertal changes around age 9 or 10 years,11 involves dramatic multi-systemic changes that influence social and affective functioning and learning.12 These include rapid physical growth, changes in endocrine function and neural development, renegotiation of family and peer

Participants

Participants were 80 youth who met DSM-IV35 criteria for a diagnosis of generalized anxiety disorder (75%), separation anxiety disorder (20%), and/or social anxiety disorder (24%), who previously received CBT (n = 54) or CCT (n = 26) as part of a randomized clinical trial37 and were subsequently enrolled in a follow-up study (Figure 1). Participants were 9 to 14 years old (mean = 11.21, SD = 1.47) at the pretreatment assessment and 11 to 17 years of age (mean = 13.56, SD = 1.52) at the 2-year

Results

The covariates added in Step 1 (gender, baseline depressive symptoms, and receipt of additional psychological services during the 2-year follow-up enrollment) collectively predicted 2-year depressive symptom scores (F4,75 = 5.01, p = .001, R2 = 0.211, adjusted R2 = 0.169). Specifically, gender (girls>boys: β = 0.463, 95% CI = 0.038−0.888], p = .033) and self-reported enrollment in community treatment during the follow-up interval (enrolled>unenrolled: β = 0.781, 95% CI = 0.312−1.250, p = .001)

Discussion

The present results indicate that anxious youth who were successfully treated with CBT for an anxiety disorder during preadolescence or early adolescence showed lower levels of depressive symptoms later in adolescence compared to anxious youth who were not successfully treated. This association between early anxiety treatment and decreased development of depressive symptoms was specific to CBT and was not found for those who responded acutely to a supportive CCT. This is the first study to

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    This work was supported by National Institute of Mental Health grant MH091327. Support for research participant recruitment was also provided by the Clinical and Translational Science Institute, University of Pittsburgh (NIH/NCRR/CTSA grant UL1 RR024153).

    The authors are grateful to the participants and their families. They are also grateful to Anthony Mannarino, PhD, of Allegheny General Hospital, for clinical supervision, and to the following University of Pittsburgh research staff and trainees for their assistance in data collection, analysis, and provision of clinical services: Laura Trubnick, Jennifer Jacubcak, Marcus Min, Jessica Wilson, Marcie Walker, Kara Colaizzi, Melissa Milbert, Katie Burkhouse, Rebecca Hartjen, Christine Larson, Abigail Martin, Kristin Pracht, Karen Garelik, Sherri Karas, Grace Chung, Suzanne Meller, Rosalind Elliott, Patricia Tan, Kristy Benoit Allen, Caroline Oppenheimer, Kyung Hwa Lee, and Lindsey Stone.

    Disclosure: Drs. Silk, Price, Ryan, Forbes, Siegle, Dahl, McMakin, Kendall, Ladouceur and Ms. Rosen report no biomedical financial interests or potential conflicts of interest.

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