Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Follow-up

Abstract

Objective: To report on the 32-week outcome of the Brief Behavioral Therapy (BBT) for Pediatric Anxiety and Depression in Primary Care clinical trial.

Method: A total of 185 youths aged 8 to 17 years with anxiety and/or depression identified through 9 pediatric primary care (PPC) settings in San Diego and Pittsburgh were randomized to receive Assisted Referral to Care (ARC) or up to 12 sessions of BBT over 16 weeks. The primary outcome was clinical response across anxiety and depression, defined as a Clinical Global Impressions-Improvement Score of ≤2. Secondary outcomes included interview-rated functioning, depression, and anxiety. Here, we report on outcomes at 32 weeks after randomization. All analyses with primary outcomes are corrected for multiple comparisons using the false discovery rate procedure.

Results: At 32 weeks, BBT was superior to ARC with respect to response (67.5% versus 43.1%, q = 0.03, number needed to treat [NNT] = 5) and functioning (d = 0.49, q = 0.04). BBT was superior to ARC with respect to its impact on anxiety (f = 0.21) but not depressive symptoms (f = 0.05). These findings persisted after controlling for the number of sessions received. Ethnicity moderated the impact of BBT on outcome (NNT for Hispanic youths = 2), because of a much lower response rate to ARC in Hispanic than in non-Hispanic youths (16.7% versus 49.2%, p = 0.04).

Conclusion: BBT is a promising intervention that can be effectively delivered in PPC and may be particularly effective for Hispanic patients. Further work is indicated to improve its impact on depressive symptoms and to test BBT against other treatments delivered in pediatric primary care.

Clinical trial registration information: Brief Cognitive Behavioral Therapy (CBT) for Pediatric Anxiety and Depression in Primary Care; https://ichgcp.net/clinical-trials-registry/NCT01147614" title="See in ClinicalTrials.gov">NCT01147614.

Keywords: anxiety; depression; primary care intervention.

Copyright © 2019 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1:. Study Flow of Participants: Screening to Analysis

Note: ARC = assisted referral to care; BBT = brief behavioral therapy.

Figure 2:. Pediatric Anxiety Rating Scale (PARS) and Children’s Depression Rating Scale-Revised (CDRS-R) Over Time

Note: Solid lines represent the Brief Behavioral Therapy (BBT) group, dashed lines the Assisted Referral to Care (ARC) group. Error bars represent 95% confidence interval.

Figure 3:. Pediatric Anxiety Rating Scale (PARS) and Children’s Depression Rating Scale-Revised (CDRS-R) Over Time by Depression

Note: Solid lines represent the Brief Behavioral Therapy (BBT) group, dashed lines the Assisted Referral to Care (ARC) group. Error bars represent 95% confidence interval