Role of Comorbid Depression and Co-occurring Depressive Symptoms in Outcomes for Anxiety-Disordered Youth Treated with Cognitive-Behavioral Therapy

Abstract

This study examined the role of comorbid depressive disorders (major depressive disorder or dysthymic disorder) and co-occurring depressive symptoms in treatment outcome and maintenance for youth (N = 72, aged 7–14) treated with cognitive-behavioral therapy for a principal anxiety disorder (generalized anxiety disorder, separation anxiety disorder, or social phobia). Hierarchical linear modeling examined treatment outcome and maintenance in terms of severity of the principal anxiety disorder. Results indicated that higher levels of child-reported depressive symptoms predicted less favorable treatment outcome. Higher levels of mother-reported depressive symptoms predicted less favorable treatment maintenance at a 1-year follow-up. Results suggest that co-occurring depressive symptoms play a role in effective treatment for anxiety-disordered youth and support the merits of treatment adaptations for these youth.

KEYWORDS:

• anxiety
• children
• comorbidity
• depression
• treatment outcome

Notes

Note. Depressive disorder = youth with a principal anxiety disorder and a comorbid depressive disorder (major depressive disorder or dysthymic disorder); No depressive disorder = youth with a principal anxiety disorder and no depressive disorder.

*p < .05. **p < .01.

Note. CDI = Children's Depression Inventory; CBCL-Affective = Child Behavior Checklist Affective Problems Scale; TRF-Affective = Teacher's Report Form Affective Problems Scale.

Analyses within brackets resulted in different intercepts. CDI, CBCL-Affective, and TRF-Affective were z-scored.

*p < .05. **p < .01. ***p < .001.

A previous report of the RCT compared the individual and family CBT treatments (Kendall, Hudson, Gosch, Flannery-Schroeder, & Suveg, 2008). The findings justify combining the individual and family conditions for the current analyses, as both conditions used the same CBT treatment, were found to produce significant improvement, and were superior to an education/support/attention treatment condition.

Analyses were conducted using a random intercept model of the form: Level 1: ANXCSR = π_0j  + π_1j post _1j  + π_2j followup _2j  + e _ij where post and followup are dummy variables that represent the posttreatment and follow-up effects of time, and DEP, CDI, CBCL-AFF, and TRF-AFF represent comorbid depressive diagnosis status (dummy-coded), child self-report depressive symptoms (z-scored), mother-report of depressive symptoms (z-scored), and teacher-report of depressive symptoms (z-scored), respectively. The level 1 equation models the within-subject effect of time on the CSR of the principal anxiety disorder for each participant. The level 2 equations model the between-subject moderating effects of the comorbid depression predictors on the level 1 relationships.