儿科初级保健中焦虑和抑郁的简短行为疗法：干预影响的广度
Brief Behavioral Therapy for Anxiety and Depression in Pediatric Primary Care: Breadth of Intervention Impact.
作者信息
Schwartz Karen T G, Kado-Walton Merissa, Dickerson John F, Rozenman Michelle, Brent David A, Porta Giovanna, Lynch Frances L, Gonzalez Araceli, Weersing V Robin
机构信息
Children's Hospital of Philadelphia, Pennsylvania; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, California.
University of California, San Diego, California; San Diego State University, California.
出版信息
J Am Acad Child Adolesc Psychiatry. 2023 Feb;62(2):230-243. doi: 10.1016/j.jaac.2022.08.007. Epub 2022 Aug 24.
OBJECTIVE
To report on broad-based outcomes of the Brief Behavioral Therapy (BBT) trial for pediatric anxiety and depression. Secondary data analyses expand on previous reports by assessing diagnostic remission and independent functioning, impact on targeted psychopathology, and spillover effects on non-targeted outcomes.
METHOD
Youth (N = 185; 8-16.9 years; 58% female; 78% White; 21% Hispanic) with anxiety and/or depression were eligible for this multi-site trial. Enrolled youth were randomly assigned to receive 8 to 12 sessions of BBT in primary care or assisted referral to outpatient care (ARC). Assessments were conducted 16 and 32 weeks post randomization.
RESULTS
BBT was superior to ARC on remission of all targeted diagnoses (week 16: 56.8% vs 28.2%, p < .001; week 32: 62.5% vs 38.9%, p = .004), clinician-rated independent functioning (week 16: 75.0% vs 45.7%, p < .001; week 32: 81.2% vs 55.7%, p < .001), and on measures of anxiety, depression, suicide items, total comorbid behavioral and emotional problems, and hyperactivity (d = 0.21-0.49). Moderation analyses revealed superior outcomes for Hispanic youth in BBT vs ARC for diagnostic remission, anxiety, emotional problems, and parent-child conflict. Youth depression at baseline moderated effects on peer problems and parent-child conflict, with effects favoring BBT. Significant main and moderated effects of BBT on change in non-targeted outcomes were largely mediated by change in anxiety (24.2%-49.3% of total effects mediated).
CONCLUSION
BBT has positive effects on youth, mediated by the strong impact of the intervention on anxiety. Analyses continue to support positive outcomes for Hispanic youth, suggesting that BBT is a broadly effective transdiagnostic treatment option for diverse populations.
CLINICAL TRIAL REGISTRATION INFORMATION
Brief Cognitive Behavioral Therapy (CBT) for Pediatric Anxiety and Depression in Primary Care; https://clinicaltrials.gov; NCT01147614.
目的
报告儿童焦虑和抑郁简短行为疗法（BBT）试验的广泛结果。二次数据分析通过评估诊断缓解和独立功能、对目标精神病理学的影响以及对非目标结果的溢出效应，对先前的报告进行了扩展。
方法
患有焦虑和/或抑郁的青少年（N = 185；8 - 16.9岁；58%为女性；78%为白人；21%为西班牙裔）符合这项多中心试验的条件。入选的青少年被随机分配接受8至12次初级保健中的BBT治疗或辅助转诊至门诊护理（ARC）。在随机分组后16周和32周进行评估。
结果
在所有目标诊断的缓解方面（第16周：56.8%对28.2%，p <.001；第32周：62.5%对38.9%，p =.004）、临床医生评定的独立功能方面（第16周：75.0%对45.7%，p <.001；第32周：81.2%对55.7%，p <.001）以及焦虑、抑郁、自杀项目、共病行为和情绪问题总数以及多动的测量方面（d = 0.21 - 0.49），BBT均优于ARC。调节分析显示，在诊断缓解、焦虑、情绪问题和亲子冲突方面，BBT组的西班牙裔青少年比ARC组有更好的结果。基线时的青少年抑郁对同伴问题和亲子冲突有调节作用，结果有利于BBT。BBT对非目标结果变化的显著主效应和调节效应在很大程度上由焦虑的变化介导（占总效应的24.2% - 49.3%）。
结论
BBT对青少年有积极影响，这是由该干预对焦虑的强烈影响介导的。分析继续支持西班牙裔青少年的积极结果，表明BBT是一种对不同人群广泛有效的跨诊断治疗选择。
临床试验注册信息
初级保健中儿童焦虑和抑郁的简短认知行为疗法（CBT）；https://clinicaltrials.gov；NCT01147614。
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