Predictors and moderators of outcome in child and adolescent anxiety and depression: a systematic review of psychological treatment studies

Abstract

The aim of this literature review was to examine pre-treatment child and adolescent characteristics as predictors and moderators of outcome in psychotherapy treatment trials of anxiety and depressive disorders. A literature search was conducted using several databases and resulted in 45 published studies (32 anxiety studies and 13 depression studies) meeting predefined methodological criteria. Ten client demographic (age, gender, ethnicity, IQ) and clinical factors (duration, type of diagnosis, pre-treatment severity, comorbidity) were examined across studies. The majority of findings showed non-significant associations between demographic factors (gender and age) with treatment outcome for both the anxiety and the depression treatment trials. Some important differences between the results of the anxiety and depression treatment trials were found. The majority of findings for the anxiety studies suggest that there are no demographic or clinical factors that predict or moderate treatment outcome. For the depression studies, however, the findings suggest that baseline symptom severity and comorbid anxiety may impact on treatment response. Overall, existing studies of pre-treatment patient variables as predictors and moderators of anxiety and depression treatment outcome provide little consistent knowledge concerning for what type of patients and under what conditions treatments work. Suggestions for future research are discussed.

The state of personalized treatment for anxiety disorders: A systematic review of treatment moderators

“…We have chosen to include all anxiety disorders classified as such in the DSM-IV since that is the period during which most of the reviewed literature was conducted Studies that failed to conduct a diagnostic interview were excluded (e.g., Zettle, 2003). Although some related reviews have specified a minimum sample size as an inclusion criterion (Nilsen et al, 2013), we chose to evaluate studies regardless of sample size because relatively few studies had met our other inclusion criteria and because evaluating the methodological quality of the extant literature (including sample size) represented a focus of this review. 2.…”

“…Moderator findings from the adult and childhood depression and childhood anxiety disorder literatures have been synthesized in reviews (Nilsen, Eisemann, & Kvernmo, 2013;Simon & Perlis, 2010). For the adult anxiety disorder literature, numerous meta-analyses and reviews of treatment predictors have been published (Eskildsen, Hougaard, & Rosenberg, 2010;Keeley, Storch, Merlo, & Geffken, 2008;Luborsky, Auerbach, Chandler, Cohen, & Bachrach, 1971;Mennin & Heimberg, 2000;Mululo, de Menezes, Vigne, & Fontenelle, 2012;Olatunji, Davis, Powers, & Smits, 2013;Pampaloni, Bruscoli, & Pallanti, 2004;Solvason, Ernst, & Roth, 2003;Steketee & Shapiro, 1995;Taylor, Abramowitz, & McKay, 2012), however, apart from obsessive-compulsive disorder (Knopp, Knowles, Bee, Lovell, & Bower, 2013), we lack a corresponding synthesis of treatment moderators.…”

Moving to Second-Stage Treatments Faster: Identifying Midtreatment Tailoring Variables for Youth with Anxiety Disorders

“…The literature on predictors of youth anxiety CBT response points toward anxiety symptom severity as a potentially promising tailoring variable; more severe anxiety at pretreatment (pre) or early in treatment significantly predicts poorer response at post (e.g., Compton et al, 2014). Unfortunately, research on other predictors of youth anxiety treatment response has yielded null or highly inconsistent findings (Nilsen, Eisemann, & Kvernmo, 2013; Silverman et al, 2008). In light of the difficulty identifying and replicating predictors of treatment response measured before treatment begins, efforts to inform moves to second stage treatment augmentation or termination may concentrate on identifying predictors measured during first stage treatment.…”

Evidence-based psychotherapy in children and adolescents: advances, methodological and conceptual limitations, and perspectives

“…mediators; e.g. therapeutic alliance and self-efficacy expectations) [24,25]. For example, few treatments have been adapted to the special needs of preschool children [10].…”