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Zink J, Weniger M, Porst PT, Siegmund CB, McDonald M, Rückert F, Roessner V, Knappe S, Beesdo-Baum K. Indicated Prevention for Children Screened in Routine Health Care: Effectiveness of a Social Skills Program on Social Anxiety and Depressive Symptoms. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01221-w. [PMID: 38963517 DOI: 10.1007/s10802-024-01221-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/05/2024]
Abstract
Social anxiety is common in childhood and potentially transitions into clinical disorders including depression. The present study aimed to examine the effectiveness of an indicated prevention program for children screened in routine care. Data came from the PROMPt project, a prospective implementation study (10/2018-09/2022) that explored a novel care chain, starting with screening with the Strengths and Difficulties Questionnaire (SDQ) as part of regular health check-ups, followed by indicated assignment and participation in a prevention program. Questionnaires assessing anxiety and depression symptoms were administered shortly after screening or before program participation (T0), six months after screening or after program participation (T1) and at a follow-up, six months after T1 (T2). Children who participated in a group cognitive-behavioral social skills program (TT; n = 145) were compared using mixed model analyses with non-participating children who were either screened as normal (NOR; n = 894) or refused program participation despite indication (NoTT; n = 67). TT scores improved from T0 to T1 compared to NOR and NoTT (anxiety β = -0.71 and β = -0.71, social anxiety β = -0.46 and β = -0.52, depression β = -0.52 and β = -0.73). Improvement was maintained at T2. Moderation analyses showed a trend toward greater benefit for participants with higher baseline scores. Indicated prevention can improve anxiety and depression symptoms in children identified by screening in routine care. Systematic screening and targeted prevention may positively affect mental health of children on a population level.
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Affiliation(s)
- Julia Zink
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Chemnitzer Straße 46, 01187, Dresden, Germany.
| | - Max Weniger
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Chemnitzer Straße 46, 01187, Dresden, Germany
| | - Patricia Theresa Porst
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Chemnitzer Straße 46, 01187, Dresden, Germany
| | - Cornelia Beate Siegmund
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Chemnitzer Straße 46, 01187, Dresden, Germany
| | - Maria McDonald
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, TUD Dresden University of Technology, Dresden, Germany
| | - Frank Rückert
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Chemnitzer Straße 46, 01187, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, TUD Dresden University of Technology, Dresden, Germany
| | - Susanne Knappe
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Chemnitzer Straße 46, 01187, Dresden, Germany
- Evangelische Hochschule Dresden (ehs), University of Applied Sciences for Social Work, Education and Nursing, Dürerstraße 25, 01307, Dresden, Germany
| | - Katja Beesdo-Baum
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Chemnitzer Straße 46, 01187, Dresden, Germany
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Warner EN, Ammerman RT, Glauser TA, Pestian JP, Agasthya G, Strawn JR. Developmental Epidemiology of Pediatric Anxiety Disorders. Child Adolesc Psychiatr Clin N Am 2023; 32:511-530. [PMID: 37201964 DOI: 10.1016/j.chc.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
This review summarizes the developmental epidemiology of childhood and adolescent anxiety disorders. It discusses the coronavirus disease of 2019 (COVID-19) pandemic, sex differences, longitudinal course, and stability of anxiety disorders in addition to recurrence and remission. The trajectory of anxiety disorders-whether homotypic (ie, the same anxiety disorder persists over time) or heterotypic (ie, an anxiety disorder shifts to a different diagnosis over time) is discussed with regard to social, generalized, and separation anxiety disorders as well as specific phobia, and panic disorder. Finally, strategies for early recognition, prevention, and treatment of disorders are discussed.
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Affiliation(s)
- Emily N Warner
- University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Environmental and Public Health Sciences, University of Cincinnati.
| | - Robert T Ammerman
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tracy A Glauser
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - John P Pestian
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Greeshma Agasthya
- Oak Ridge National Laboratory, Computational Sciences and Engineering Division, Advanced Computing for Health Sciences Section
| | - Jeffrey R Strawn
- University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Psychiatry, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Morales-Muñoz I, Palmer ER, Marwaha S, Mallikarjun PK, Upthegrove R. Persistent Childhood and Adolescent Anxiety and Risk for Psychosis: A Longitudinal Birth Cohort Study. Biol Psychiatry 2022; 92:275-282. [PMID: 35151465 PMCID: PMC9302897 DOI: 10.1016/j.biopsych.2021.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Persistent anxiety in childhood and adolescence could represent a novel treatment target for psychosis, potentially targeting activation of stress pathways and secondary nonresolving inflammatory response. Here, we examined the association between persistent anxiety through childhood and adolescence with individuals with psychotic experiences (PEs) or who met criteria for psychotic disorder (PD) at age 24 years. We also investigated whether C-reactive protein mediated any association. METHODS Data from the Avon Longitudinal Study of Parents and Children (ALSPAC) were available in 8242 children at age 8 years, 7658 at age 10 years, 6906 at age 13 years, and 3889 at age 24 years. The Development and Well-Being Assessment was administered to capture child and adolescent anxiety. We created a composite score of generalized anxiety at ages 8, 10, and 13. PEs and PD were assessed at age 24, derived from the Psychosis-like Symptoms Interview. The mean of C-reactive protein at ages 9 and 15 years was used as a mediator. RESULTS Individuals with persistent high levels of anxiety were more likely to develop PEs (odds ratio 2.02, 95% CI 1.26-3.23, p = .003) and PD at age 24 (odds ratio 4.23, 95% CI 2.27-7.88, p < .001). The mean of C-reactive protein at ages 9 and 15 mediated the associations of persistent anxiety with PEs (bias-corrected estimate -0.001, p = .013) and PD (bias-corrected estimate 0.001, p = .003). CONCLUSIONS Persistent high levels of anxiety through childhood and adolescence could be a risk factor for psychosis. Persistent anxiety is potentially related to subsequent psychosis via activation of stress hormones and nonresolving inflammation. These results contribute to the potential for preventive interventions in psychosis, with the novel target of early anxiety.
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Affiliation(s)
- Isabel Morales-Muñoz
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom; Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - Edward R. Palmer
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom,Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom,Specialist Mood Disorders Clinic, Zinnia Centre, Birmingham, United Kingdom,Barberry National Centre for Mental Health, Birmingham, United Kingdom
| | - Pavan K. Mallikarjun
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom,Early Intervention Service, Birmingham Women’s and Children’s NHS Trust, Birmingham, United Kingdom
| | - Rachel Upthegrove
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom,Early Intervention Service, Birmingham Women’s and Children’s NHS Trust, Birmingham, United Kingdom
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Steinsbekk S, Ranum B, Wichstrøm L. Prevalence and course of anxiety disorders and symptoms from preschool to adolescence: a 6-wave community study. J Child Psychol Psychiatry 2022; 63:527-534. [PMID: 34318492 DOI: 10.1111/jcpp.13487] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND The rate of various anxiety disorders in early childhood and whether they continue into middle childhood or adolescence is not known. We therefore report on the prevalence and stability of DSM-5-defined anxiety disorders and their symptoms, capturing the period from preschool to adolescence. METHODS By means of interviewer-based clinical interviews, anxiety was measured in a sample of Norwegian children at six measurement points from age 4 to 14 (n = 1,041). To adjust for time-invariant factors, we applied random intercept cross-lagged panel models (RI-CLPMs) capturing within-person changes. RESULTS Nearly 10% (95% CI = 7.29, 12.63) had an anxiety disorder at some timepoint. Specific phobia was the most prevalent disorder in early and middle childhood, whereas generalized anxiety disorder (GAD) increased in prevalence and became the most common anxiety disorder at age 14 (4.51%, 95% CI = 2.78, 6.23). When time-invariant confounding was adjusted for, homotypic continuity in anxiety symptoms typically first emerged in late middle childhood or adolescence. Even so, such within-person analyses revealed a heterotypic path from increased number of early childhood symptoms of specific phobia to increased number of GAD symptoms in middle childhood (B = .41, 95% CI = .06, .75). Increased separation anxiety in middle childhood predicted increased symptoms of GAD in adolescence (B = .38, 95% CI = .14, .62), and vice versa (B = .05, 95% CI = .00, .09). Only minor gender differences were revealed. CONCLUSIONS Anxiety disorders are prevalent in childhood. In early childhood, anxiety symptoms generally do not predict later anxiety symptoms. In middle childhood, however, such symptoms are less likely to vanish, indicating this developmental period to be particularly important for preventive and treatment efforts.
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Affiliation(s)
- Silje Steinsbekk
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bror Ranum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Wichstrøm
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Child and Adolescent Psychiatry, St. Olavs University Hospital, Trondheim, Norway
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Gong J, Wang MC, Zhang X, Yang W. Measurement invariance and psychometric properties of the Spence Children’s anxiety scale-short version (SCAS-S) in Chinese students. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02237-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ho SM, Zhang Q, Lai Y, Dai DWT. Cognitive vulnerabilities to anxiety symptoms among Chinese adolescents: A 3-year longitudinal study. J Clin Psychol 2021; 77:1700-1714. [PMID: 33951200 DOI: 10.1002/jclp.23161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/26/2021] [Accepted: 04/12/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study established cognitive vulnerability of anxiety symptoms among high school students. METHOD A total of 72 grade 9-11 students completed measures on levels of anxiety sensitivity (AS), selective attentional processing, and anxiety symptoms annually between 2016 and 2018. RESULTS Latent class growth analysis (unconditional model) showed a four-class model: High (stable) (6.94%), low (stable) (11.11%), medium (decreasing) (61.11%), and medium (increasing) (20.83%). The conditioned model controlling for the physical-concerns dimension of AS and negative attentional bias demonstrated that a two-class model consisted of a low anxiety class (n = 59, 81.9%) and a high anxiety class (n = 13, 18.1%) provided the best fit for the data. Negative attentional bias is a significant factor related to the development of anxiety trajectories. CONCLUSION Attentional bias modification to disengage from negative stimuli may serve as a potential target of intervention to reduce chronic anxiety among high school students.
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Affiliation(s)
- Samuel My Ho
- Psychology Laboratory, Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Qiaochu Zhang
- Psychology Laboratory, Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Yihuan Lai
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Darren W T Dai
- Department of Educational Psychology, Tsung Tsin Mission of Hong Kong, Hong Kong, China
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Co-Developmental Trajectories of Specific Anxiety Symptoms from Middle Childhood to Early Adolescence: Associations with Psychological Well-Being and Academic Achievement. J Youth Adolesc 2021; 50:1140-1156. [PMID: 33675506 DOI: 10.1007/s10964-021-01411-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 01/02/2023]
Abstract
Different types of specific anxiety symptoms commonly co-occur but also display distinct developmental trajectories over time in children and adolescents. Nevertheless, little is known about the co-developmental trajectories of specific anxiety symptoms among youth during the transition into adolescence and how identified trajectories are associated with important psychological and academic outcomes. This study thus aimed to determine the (a) heterogeneous co-developmental trajectories of five specific anxiety symptoms (generalized anxiety, separation anxiety, social anxiety, school anxiety, and panic disorder) from middle childhood to early adolescence, and (b) associations between the identified, distinct trajectories and youth's psychological well-being and academic achievement. A total of 715 Chinese elementary school students (45.6% girls, Mage = 8.96, SD = 0.76) completed measures on six occasions across three years, using 6-month intervals. Parallel process latent class growth modeling revealed five distinct anxiety trajectory groups: "congruent-low" (49.8%), "moderately low with predominant social anxiety" (18.5%), "moderately low with predominant school anxiety" (12.6%), "moderately high with predominant generalized and social anxiety" (8.6%), and "congruent-high" (10.5%). The lowest psychological well-being and academic achievement were observed for youth who persistently experienced the co-occurrence of two or more specific anxiety symptoms, followed by those who persistently experienced one predominant anxiety symptom, and finally, youth who persistently experienced low levels of all five specific anxiety symptoms. The identification of five heterogeneous groups with differential outcomes highlights the importance of individual differences considerations in understanding the co-developmental patterns of specific anxiety symptoms from middle childhood to early adolescence and the need for more sophisticated intervention programs tailored to members of specific groups to promote optimal psychological well-being and academic success.
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Bushnell GA, Talati A, Wickramaratne PJ, Gameroff MJ, Weissman MM. Trajectories of childhood anxiety disorders in two generations at high risk. Depress Anxiety 2020; 37:521-531. [PMID: 32058635 PMCID: PMC7292740 DOI: 10.1002/da.23001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/30/2019] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The course of anxiety disorders during childhood is heterogeneous. In two generations at high or low risk, we described the course of childhood anxiety disorders and evaluated whether parent or grandparent major depressive disorder (MDD) predicted a persistent anxiety course. METHODS We utilized a multigenerational study (1982-2015), following children (second generation, G2) and grandchildren (third generation, G3) of generation 1 (G1) with either moderate/severe MDD or no psychiatric illness. Psychiatric diagnoses were based on diagnostic interviews. Using group-based trajectory models, we identified clusters of children with similar anxiety disorder trajectories (age 0-17). RESULTS We identified three primary trajectories in G2 (N = 275) and G3 (N = 118) cohorts: "no/low anxiety disorder" during childhood (G2 = 66%; G3 = 53%), "nonpersistent" with anxiety during part of childhood (G2 = 16%; G3 = 21%), and "persistent" (G2 = 18%; G3 = 25%). Childhood mood disorders and substance use disorders tended to be more prevalent in children in the persistent anxiety trajectory. In G2 children, parent MDD was associated with an increased likelihood of being in the persistent (84%) or nonpersistent trajectory (82%) versus no/low anxiety trajectory (62%). In G3 children, grandparent MDD, but not parent, was associated with an increased likelihood of being in the persistent (83%) versus nonpersistent (48%) and no/low anxiety (51%) trajectories. CONCLUSION Anxiety trajectories move beyond what is captured under binary, single time-point measures. Parent or grandparent history of moderate/severe MDD may offer value in predicting child anxiety disorder course, which could help clinicians and caregivers identify children needing increased attention and screening for other psychiatric conditions.
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Affiliation(s)
- Greta A. Bushnell
- Department of Epidemiology at the Columbia University
Mailman School of Public Health
| | - Ardesheer Talati
- Department of Psychiatry at the Columbia University Vagelos
College of Physicians and Surgeons,Division of Translational Epidemiology at New York State
Psychiatric Institute
| | - Priya J. Wickramaratne
- Department of Psychiatry at the Columbia University Vagelos
College of Physicians and Surgeons,Division of Translational Epidemiology at New York State
Psychiatric Institute,Department of Biostatistics at the Columbia University
Mailman School of Public Health
| | - Marc J. Gameroff
- Department of Psychiatry at the Columbia University Vagelos
College of Physicians and Surgeons,Division of Translational Epidemiology at New York State
Psychiatric Institute
| | - Myrna M. Weissman
- Department of Epidemiology at the Columbia University
Mailman School of Public Health,Department of Psychiatry at the Columbia University Vagelos
College of Physicians and Surgeons,Division of Translational Epidemiology at New York State
Psychiatric Institute
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Sundell K, Eklund J, Ferrer-Wreder L. Stability and Change in Patterns of Adolescent Antisocial Behavior. J Pers Oriented Res 2019; 5:1-16. [PMID: 33569137 PMCID: PMC7842611 DOI: 10.17505/jpor.2019.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Research examining relations between various types of antisocial behavior (ASB) have generally been based on cross-sectional data. Although there is a strong correlation between types of ASB, it has been less common to examine how patterns of adolescents’ problems vary over time. This study used a person-oriented approach to examine patterns of ASB in adolescents longitudinally and also investigated how these patterns were associated with three outcomes. The sample consisted of 778 Swedish adolescents in grade 7 (13 years old) followed over time to grade 9. Patterns of ASB were identified based on adolescent-reported tobacco and alcohol use, truancy, bullying in school, and delinquency. The outcomes were drug use, depressive symptoms, and missing grades in grade 9. Results revealed an escalation in the frequency and seriousness of ASB over time, although the largest single cluster over time evidenced no ASB. One cluster in particular increased the risk of drug use, depression, and missing grades at grade 9. Results are discussed in relation to school-based prevention efforts.
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Affiliation(s)
- Knut Sundell
- Medical Management Centre, Department of Learning, Informatics, Management, & Ethics, Karolinska Institutet, Sweden
| | - Jenny Eklund
- Department of Public Health Sciences, Stockholm University, Sweden
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