One-year stability, change and incidence in anxiety symptoms among early adolescents in the general population

One-year recovery rates for young people with depression and/or anxiety not receiving treatment: a systematic review and meta-analysis

OBJECTIVES

To systematically review 1-year recovery rates for young people experiencing depression and/or anxiety who are not receiving any specific mental health treatment.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, Embase, PsycINFO, Web of Science and Global Health were searched for articles published from 1980 through to August 2022.

ELIGIBILITY CRITERIA

Articles were peer-reviewed, published in English and had baseline and 1-year follow-up depression and/or anxiety outcomes for young people aged 10-24 years without specific treatment.

DATA EXTRACTION AND SYNTHESIS

Three reviewers extracted relevant data. Meta-analysis was conducted to calculate the proportion of individuals classified as recovered after 1 year. The quality of evidence was assessed by the Newcastle-Ottawa Scale.

RESULTS

Of the 17 250 references screened for inclusion, five articles with 1011 participants in total were included. Studies reported a 1-year recovery rate of between 47% and 64%. In the meta-analysis, the overall pooled proportion of recovered young people is 0.54 (0.45 to 0.63).

CONCLUSIONS

The findings suggest that after 1 year about 54% of young people with symptoms of anxiety and/or depression recover without any specific mental health treatment. Future research should identify individual characteristics predicting recovery and explore resources and activities which may help young people recover from depression and/or anxiety.

PROSPERO REGISTRATION NUMBER

CRD42021251556.

Agreement, Stability, and Validity of Parent- and Youth-Reported Anxiety Symptoms from Childhood to Adolescence

The current study examined changes in the agreement, stability, and concurrent and predictive validity of parent- and self-reports on a frequently used measure of youth anxiety symptoms, the Screen for Child Anxiety Related Emotional Disorders (SCARED), from age 9 to 15. A community sample of 531 families (youth, mothers, and fathers) completed the SCARED and a semi-structured diagnostic interview when children were ages 9, 12, and 15. Agreement between youth and each parent on youth anxiety symptoms was weak at age 9 (r = 0.12-0.17), but moderate at age 12 (r = 0.31-0.36) and 15 (r = 0.31-0.46); mother-father (r = 0.50-0.53) agreement was greater than youth-parent agreement at every wave. Stability of youth-reported symptoms was low between age 9 and 12 (r = 0.25), but much higher from age 12 to 15 (r = 0.57); mother- and father-reported youth anxiety symptoms demonstrated high stability (r = 0.53-0.74) at both intervals. Self- and parent-reported youth symptoms were both significantly associated with youth anxiety disorder status, cross-sectionally and prospectively. When considered simultaneously at age 9, only parent-reported anxiety symptoms uniquely predicted concurrent and subsequent youth anxiety diagnoses. However, by age 12, parent- and youth-reported anxiety symptoms were each independently associated with concurrent and subsequent anxiety diagnoses. Agreement, stability, and concurrent and predictive validity of youth self-reported anxiety symptoms are poorer than parent-reports in middle childhood, but comparable by middle adolescence. However, all reporters provide unique information about youth anxiety at each of the developmental periods examined.

Comparative efficacy and safety of traditional Chinese patent medicine for anxiety disorders in children or adolescence: A protocol for systematic review and network meta-analysis

BACKGROUND

Anxiety is the most common mental illness among adolescents and children, and its incidence is increasing year by year, which has a serious adverse effect on the academic and growth of adolescents and children. Conventional treatment methods such as oral administration of western medicine and psycho-behavioral therapy have obvious limitations. Chinese patent medicines play an irreplaceable role in the treatment of this disease. At present, there is no comparison of the safety and effectiveness of various Chinese patent medicines curing anxiety in adolescents. So we take advantage of the method of network meta-analysis to systematically compare the efficacy of various Chinese patent medicines curing this disease.

METHODS

We will systematically and comprehensively search the following databases, including PubMed, Web of Science, EMBASE, The Cochrane Library, China BioMedical Literature (CBM), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wanfang database. We will include all RCT trials that meet the inclusion criteria, starting from the establishment of the database until August 2020. Two researchers will independently screen the literature based on inclusion criteria. While extracting data, we also assess the risk of bias in the included studies. All the data and evidence obtained will be evaluated by the method of Bayesian network meta-analysis. STATA and WinBUGS software will be used.

RESULTS

This study will evaluate the effectiveness and safety of various TCPMs for anxiety disorders in children or adolescence.

CONCLUSION

The results of this study will provide valuable references for the clinical application of Traditional Chinese patent medicines, and assist clinicians in formulating more reasonable diagnosis and treatment strategies.

ETHICS AND DISSEMINATION

This study does not require ethical approval.

INPLASY REGISTRATION NUMBER

INPLASY202080048.

A Current Review of the Children and Young People's Improving Access to Psychological Therapies (CYP IAPT) Program: Perspectives on Developing an Accessible Workforce

The CYP IAPT program has played a leading role in workforce development in the Child and Adolescent Mental Health Service (CAMHS) in England since its inception in 2011. Despite promising evidence of CYP IAPT's benefits, significant wait times for CAHMS have convinced policy makers that a new direction for CYP IAPT is required. Since 2017, the CYP IAPT program has changed its aim from workforce development to workforce expansion, with the project aiming to train 1700 new psychological practitioners by 2021. The CYP IAPT program now consists of three training streams (a) a low-intensity workforce, (b) a schools-based workforce, and (c) a high-intensity workforce based on the original CYP IAPT curriculum. The purpose of this paper is to outline the three CYP IAPT workforce streams. As will be reviewed, changes to CYP IAPT have occurred within the context of emerging ideas from dissemination science and government reviews that outline the shortcomings of traditional service models. Consequently, CYP IAPT practitioners are now increasingly being trained in the delivery of novel psychological interventions to address some of these shortcomings. A range of low-intensity interventions are being deployed by CYP IAPT practitioners to target mild-to-moderate anxiety, depression, and conduct. A recent meta-analysis indicates that low-intensity psychological interventions show promise for children and adolescents in efficacy trials. Nevertheless, further research is required to understand its effectiveness in real-world settings and to see if treatment effects are sustained over time. As such, this paper recommends that CYP IAPT services evaluate the long-term effectiveness of low-intensity work and subject their methods and findings to peer review.

Dental anxiety in 18-year-old Norwegians in 1996 and 2016

Objective: To estimate the prevalence of dental anxiety, and to explore factors that may increase the risk of reporting dental anxiety among 18-year-old Norwegians in 2016. A further objective was to report changes in dental anxiety since 1996.Material and methods: An anonymous survey from a strategic sample of upper secondary students (n = 351) in 2016 with high response rate (93%) was compared with the results of an investigation of a similar population conducted in 1996.Results: The prevalence of dental anxiety and dental distrust was reduced from 1996 to 2016. Dental Fear Survey (DFS) from 19 to 8% (p < .001), and Dental Belief Survey (DBS) from 15 to 6% (p < .001). Geer Fear Scale (GFS) which measure phobic anxiety did not show a similar reduction (17 versus 15%, p = .37). Phobic anxiety, avoidance behaviour, self-reported poor oral health and previous experiences of pain were all associated with dental anxiety.Conclusion: The prevalence of dental anxiety was reduced from 1996 to 2016, but 8% still report dental anxiety. Proper pain management and use of behavioural management techniques still needs to be highlighted to prevent development of dental anxiety, avoidance behaviour and poor oral health.

Pathways from parental mental disorders to offspring's work disability due to depressive or anxiety disorders in early adulthood-The 1987 Finnish Birth Cohort

BACKGROUND

Parental mental disorders have been shown to predict offspring's mental health problems. We examined whether pathways from parental mental disorders to offspring's psychiatric work disability in early adulthood are mediated through offspring's mental disorders and social disadvantage in adolescence.

METHODS

Study population consisted of the 1987 Finnish Birth Cohort. Data on parents' psychiatric care or work disability due to mental diagnosis between 1987 and 2000 and the cohort participants' health and social factors between 2001 and 2005 were derived from administrative national registers. From 2006 through 2015, 52,182 cohort participants were followed for admittance of psychiatric work disability due to depressive or anxiety disorders. First, we applied a pathway analysis to examine the occurrence of each path. We then used mediation analysis to assess the proportion of association between parental mental disorders and work disability mediated by offspring's health and social disadvantage.

RESULTS

The pathway model indicated that the association from parental mental disorders to offspring's work disability due to depressive or anxiety disorder is through mental disorders and social disadvantage in adolescence. Odds Ratio for the total effect of parental mental disorders on offspring's psychiatric work disability was 1.85 (95% confidence interval [CI] 1.46-2.34) in the model including offspring's mental disorders that mediated this association by 35%. Corresponding results were 1.86 (95% CI 1.47-2.35) and 28% for social disadvantage in adolescence.

CONCLUSIONS

These findings suggest that intergenerational determination of work disability due to mental disorders could be addressed by actions supporting mental health and social circumstances in adolescence.

The Validity of the Screen for Child Anxiety Related Emotional Disorders Revised (SCARED-R) Scale and Sub-Scales in Swedish Youth

We evaluated the clinical utility of the Swedish SCARED-R in child- and adolescent psychiatric outpatients (n = 239) and validated it against Longitudinal Expert All Data (LEAD) DSM IV diagnoses based on the Children's Schedule for Affective Disorders and Schizophrenia (KSADS) and subsequent clinical work-up and treatment outcome. The SCARED-R total score and subscales had acceptable sensitivity/specificity for child and parent reports for cut-offs based on Receiver Operating Characteristics (ROC) curves, with mostly moderate area under the curve. Sensitivity ranged from 75% (parent rated social anxiety) to 79% [child rated Generalized Anxiety Disorder (GAD)]. Specificity, ranged from 60% for child-rated GAD to 88% for parent rated social anxiety. Parent-child agreement was moderate, and each informant provided unique information contributing to most diagnoses. In conclusion, the SCARED-R is useful for screening anxiety symptoms in clinical populations. However, it cannot replace interview based diagnoses, nor is it adequate to use just one informant.

The natural course of anxiety symptoms in early adolescence: factors related to persistence

BACKGROUND AND OBJECTIVES

Anxiety disorders are the most common mental health problems during childhood and adolescence. This study examined the course of anxiety symptoms in early adolescents from the general population over three phases.

DESIGN

Prospective cohort study.

METHODS

Two hundred and forty-two participants (mean-age of 13.52) from a baseline sample of 1514 (mean-age of 10.23) were followed up three times. Of the 1514 children, those with emotional risk and controls without risk constituted the second-phase sample (n = 562; mean-age of 11.25). The Screen for Child Anxiety Related Emotional Disorders-SCARED was administered in all three phases.

RESULTS

Fifty-six percent and 32% of respondents showed total scores above the SCARED cutoff point at one and three years follow-up, respectively. Eight percent showed fluctuating symptoms. Fifty-five percent of respondents showed high scores for any subtype of anxiety over three years. Social phobia and generalized anxiety symptoms were the most prevalent and persistent. Participants with persistent separation anxiety showed the highest co-occurrence with symptoms of other psychopathological disorders. Participants with persistent anxiety showed lower academic performance. Being male was a protective factor against persistence.

CONCLUSIONS

The data support anxiety maintenance during early adolescence. Early adolescence is a critical period which may involve other serious academic, social, and family problems.

Negative Life Events, Social Support, and Self-Efficacy in Anxious Adolescents

PURPOSE

To examine the prevalence and correlates of anxiety in a community sample of adolescents. Knowing the prevalence and characteristics of anxious adolescents is valuable to improve anxiety prevention strategies and interventions.

DESIGN

Cross-sectional data about anxiety were collected via a school survey from a community sample of Norwegian adolescents aged 12-17 (N = 1719).

METHODS

Based on scores from the Spence Children's Anxiety Scale, the adolescents were categorized as not anxious or anxious. Logistic regression analysis was performed to access the impact of each factor on the likelihood that participants would report an elevated level of anxiety.

RESULTS

A total of 22% of the adolescents were categorized as anxious. Female gender, experienced negative life events, low social support, and low self-efficacy were associated with elevated level of anxiety.

CONCLUSIONS

The high prevalence of anxiety in adolescents demonstrates the importance of improved prevention interventions targeting anxious adolescents. We argue that addressing is the responsibility of not only the individual adolescents and their families but also schools, school health services, and policy makers. School-based interventions that increase social support and self-efficacy would probably be particularly beneficial for anxious adolescents.

Examining associations between anxiety and cortisol in high functioning male children with autism

Background

Autism spectrum disorder (ASD) is characterized by deficits in communication and social ability, as well as restricted interests and repetitive behavior. Anxiety is a persistent anticipation or apprehension about one or more situations to which a person is exposed, and affects many people, including children with ASD. Stress, by contrast, is a response to situations that are threatening, uncontrollable, or unexpected. Indices of anxiety are often measured through informants, with parents and teachers serving as the primary sources of reported anxiety in children. However, self-report measures exist, allowing current (state) and persistent (trait) anxiety to be assessed. The current study was designed to evaluate whether children with autism could identify their own levels of anxiety and the degree to which these levels were associated with symptom profile and physiological arousal.

Methods

Self-reported state and trait anxiety were collected during exposure to different stress paradigms for 40 children (21 typically developing, 19 with autistic disorder) and compared to parent reported social ability (Social Responsiveness Scale) and stress responsivity (cortisol).

Results

Significant differences were found between typically developing and children with autism for both state and trait anxiety across all conditions. Associations were identified between severity of parent-reported social impairment and both types of self-report anxiety. No relationship was found between stress (salivary cortisol) and anxiety in children with autism.

Conclusions

Children with autism are able to consistently report their persistent level of anxiety symptoms in stressful situations of benign character. Therefore, the inclusion of such measures may be useful in identifying and tracking symptoms in children with autism under appropriate circumstances.