Antonacci Chase, Zugman André, Morales Isaac, Cardinale Elise M, Frank Samuel E C, Lewis Krystal M, Berman Erin, Gotlib Ian H, Pine Daniel S
Department of Psychology, Stanford University, Building 420, 450 Jane Stanford Way, Stanford, CA, USA.
Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, USA.
Psychiatry Res. 2025 Jun;348:116484. doi: 10.1016/j.psychres.2025.116484. Epub 2025 Apr 1.
Early adversity is a well-documented risk factor for anxiety disorders in youth; few studies, however, have examined how exposure to adversity influences treatment outcomes. Emerging research suggests that systemic inequities can affect the efficacy of frontline psychotherapies. The effects of structural disadvantage and, in particular, neighborhood-level features on treatment outcomes for pediatric anxiety are largely under-studied. The current study aimed to examine the impact of neighborhood opportunity on children's response to cognitive behavioral therapy (CBT). A total of 202 youth aged 8-17 years (M = 12.030, 56 % F) with a diagnosed anxiety disorder completed 8-12 weeks of exposure-based CBT. Neighborhood disadvantage was quantified using the Child Opportunity Index (COI), and treatment response was measured via the Pediatric Anxiety Rating Scale (PARS) at baseline, post-treatment, and a 6-month follow-up assessment. Following treatment, anxious youth exhibited a significant 31.523 % reduction in symptoms. Across all scoring dimensions of the COI (socioeconomic, education, and health & environment), neighborhood disadvantage did not reliably predict treatment response. These findings suggest that when provided access to high-quality, evidence-based psychotherapy, youth from lower opportunity neighborhoods achieve comparable outcomes to their more advantaged peers. Taken together with prior research, this study suggests that structural disadvantage at the neighborhood level is not a robust predictor of treatment outcomes in the context of pediatric anxiety. These findings raise the possibility that equitable access to treatment could, in certain circumstances, mitigate the negative effects of systemic neighborhood-level inequities on mental health outcomes, underscoring the importance of expanding the availability of treatment services.
早期逆境是青少年焦虑症一个有充分文献记载的风险因素；然而，很少有研究探讨接触逆境如何影响治疗效果。新兴研究表明，系统性不平等会影响一线心理治疗的疗效。结构劣势，尤其是社区层面的特征对儿童焦虑症治疗效果的影响在很大程度上尚未得到充分研究。当前的研究旨在探讨社区机会对儿童认知行为疗法（CBT）反应的影响。共有202名年龄在8至17岁之间（平均年龄M = 12.03岁，女性占56%）且被诊断患有焦虑症的青少年完成了为期8至12周的基于暴露的CBT治疗。使用儿童机会指数（COI）对社区劣势进行量化，并在基线、治疗后以及6个月的随访评估中通过儿童焦虑评定量表（PARS）测量治疗反应。治疗后，焦虑青少年的症状显著减轻了31.523%。在COI的所有评分维度（社会经济、教育以及健康与环境）中，社区劣势并不能可靠地预测治疗反应。这些发现表明，当能够获得高质量的循证心理治疗时，来自机会较少社区的青少年能取得与条件更优越的同龄人相当的治疗效果。结合先前的研究，本研究表明，在儿童焦虑症的背景下，社区层面的结构劣势并非治疗效果的有力预测因素。这些发现增加了一种可能性，即在某些情况下，公平获得治疗可以减轻社区层面系统性不平等对心理健康结果的负面影响，凸显了扩大治疗服务可及性的重要性。
