A randomised controlled trial of treatments of childhood anxiety disorder in the context of maternal anxiety disorder: clinical and cost-effectiveness outcomes

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Creswell, C., Violato, M., Cruddace, S., Gerry, S., Murray, L., Shafran, R., Stein, A., Willetts, L., McIntosh, E. and Cooper, P. J. (2020) A randomised controlled trial of treatments of childhood anxiety disorder in the context of maternal anxiety disorder: clinical and cost-effectiveness outcomes. Journal of Child Psychology and Psychiatry, 61 (1). pp. 62-76. ISSN 1469-7610 doi: 10.1111/jcpp.13089

Abstract/Summary

Background: This study evaluated whether clinical and economic outcomes from CBT for child anxiety disorders in the context of maternal anxiety disorders are improved by adding treatment focused on (i) maternal anxiety disorders, or (ii) mother-child interactions. Methods: 211 children (7 – 12 years, 85% White British, 52% female) with a primary anxiety disorder, whose mothers also had a current anxiety disorder, were randomised to receive (i) child-focused CBT with non-specific control interventions (CCBT+Con), (ii) CCBT with CBT for the maternal anxiety disorder (CCBT+MCBT), or (iii) CCBT with an intervention targeting the mother-child interaction (CCBT+MCI). A cost-utility analysis from a societal perspective was conducted using mother/child combined Quality Adjusted Life Years (QALYs). [Trial registration: https://doi.org/10.1186/ISRCTN19762288]. Results: MCBT was associated with immediate reductions in maternal anxiety compared to the non-specific control; however, after children had also received CCBT, maternal outcomes in the CCBT+MCI and CCBT+Con arms improved and CCBT+MCBT was no longer superior. Neither CCBT+MCBT nor CCBT+MCI conferred a benefit over CCBT+Con in terms of child anxiety disorder diagnoses post-treatment [primary outcome] (adj RR: 1.22 (95% CI 0.88, 1.67), p = .23; adj RR: 1.21 (95% CI 0.88, 1.65), p = .24 respectively) or global improvement ratings (adj RR 1.25 (95% CI 0.99, 1.57), p = .06; adj RR 1.18 (95% CI 0.93, 1.50), p = .17) or six and 12 months later. No significant differences between the groups were found on the main economic outcome measures (child/mother combined QALY mean difference: CCBT+MCBT vs CCBT+Con: -0.04 (95% CI -0.12, 0.04), p = 0.29; CCBT+MCI vs CCBT+Con: 0.02 (95% CI -0.05, -0.09), p = 0.54). CCBT+MCI was associated with non-significantly higher costs than CCBT (mean difference: £154 (95% CI -£1239, £1547), p = 0.83) but, when taking into account sampling uncertainty, it may be cost-effective compared with CCBT alone. Conclusions: Good outcomes were achieved for children and their mothers across treatment arms. There was no evidence of significant clinical benefit from supplementing CCBT with either CBT for the maternal anxiety disorder or treatment focussed on mother-child interactions, but the addition of MCI (and not MCBT) may be cost-effective. Keywords: Child; anxiety; mother; parent-child interaction; CBT.

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Item Type	Article
URI	https://reading-clone.eprints-hosting.org/id/eprint/85345
Item Type	Article
Refereed	Yes
Divisions	Life Sciences > School of Psychology and Clinical Language Sciences > Anxiety and Depression in Young People (AnDY) Life Sciences > School of Psychology and Clinical Language Sciences > Department of Psychology Life Sciences > School of Psychology and Clinical Language Sciences > Development Life Sciences > School of Psychology and Clinical Language Sciences > Psychopathology and Affective Neuroscience
Publisher	Wiley
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Date Deposited:	08 Aug 2019 13:53	Date item deposited into CentAUR
Last Modified:	31 Mar 2025 02:44	Date item last modified

References

• BDA. (2003). Family Health. British Dietetic Association, UK • Bodden, D. H., Bögels, S. M., Nauta, M. H., De Haan, E., Ringrose, J., Appelboom, C., . . . Appelboom-Geerts, K. C. (2008a). Child versus family cognitive-behavioral therapy in clinically anxious youth: an efficacy and partial effectiveness study. Journal of the American Academy of Child & Adolescent Psychiatry, 47(12), 1384-1394. • Bodden, D. H., Dirksen, C. D., & Bogels, S. M. (2008b). Societal burden of clinically anxious youth referred for treatment: A cost-of-illness study. Journal of Abnormal Child Psychology, 36(4), 487-497. doi:10.1007/s10802-007-9194-4 • Bögels, S., & Perotti, E. (2011). Does father know best? A formal model of the paternal influence on childhood social anxiety. Journal of Child and Family Studies, 20(2), 171-181. • Borkovec, T., & Costello, E. (1993). Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 61(4), 611. • Brown, T. A., Barlow, D. H., & DiNardo, P. A. (1994). Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV): Client Interview Schedule: Graywind Publications Incorporated. • Cobham, V. E., Dadds, M. R., & Spence, S. H. (1998). The role of parental anxiety in the treatment of childhood anxiety. Journal of Consulting and Clinical Psychology, 66(6), 893-905. doi:10.1037/0022-006X.66.6.893 • Connell, A. M., & Goodman, S. H. (2002). The association between psychopathology in fathers versus mothers and children's internalizing and externalizing behavior problems: A meta-analysis. Psychological Bulletin, 128(5), 746-773. doi:10.1037/0033-2909.128.5.746 • Cooper, P. J., Fearn, V., Willetts, L., Seabrook, H., & Parkinson, M. (2006). Affective disorder in the parents of a clinic sample of children with anxiety disorders. Journal of Affective Disorders, 93(1-3), 205-212. • Costello, E. J., Egger, H. L., & Angold, A. (2004). Developmental Epidemiology of Anxiety Disorders. In T. H. Ollendick & J. S. March (Eds.), Phobic and anxiety disorders in children and adolescents: A clinician's guide to effective psychosocial and pharmacological interventions (pp. 61-91). New York, NY, US: Oxford University Press. http://dx.doi.org/10.1093/med:psych/9780195135947.003.0003 • Creswell, C., Apetroaia, A., Murray, L., & Cooper, P. (2013). Cognitive, affective, and behavioral characteristics of mothers with anxiety disorders in the context of child anxiety disorder. Journal of Abnormal Psychology, 122(1), 26. • Creswell, C., Murray, L., Stacey, J., & Cooper, P. J. (2011). Parenting and child anxiety. In W. K. Silverman & A. P. Field (Eds.), Anxiety disorders in children and adolescents (2nd ed., pp. 299-322). Cambridge: Cambridge University Press. • Creswell, C., Violato, M., Fairbanks, H., White, E., Parkinson, M., Abitabile, G., . . . Cooper, P. J. (2017). Clinical outcomes and cost-effectiveness of brief guided parent-delivered cognitive behavioural therapy and solution-focused brief therapy for treatment of childhood anxiety disorders: a randomised controlled trial. The Lancet Psychiatry, 4(7), 529-539. • Dolan, P., Gudex, C., Kind, P., & Williams, A. (1995). A social tariff for EuroQol: results from a UK general population survey: Centre for Health Economics University of York, UK. • Drummond, M. F., Sculpher, M. J., Claxton, K., Stoddart, G. L., & Torrance, G. W. (2015). Methods for the economic evaluation of health care programmes: Oxford University Press. • Essau, C. A., Conradt, J., & Petermann, F. (2000). Frequency, comorbidity and psychosocial impairment of anxiety disorders in German adolescents. Journal of Anxiety Disorders, 14(3), 263-279. doi:10.1016/S0887-6185(99)00039-0 • Faria, R., Gomes, M., Epstein, D., & White, I. R. (2014). A guide to handling missing data in cost-effectiveness analysis conducted within randomised controlled trials. Pharmacoeconomics, 32(12), 1157-1170. • Fenwick, E., Marshall, D. A., Levy, A. R., & Nichol, G. (2006). Using and interpreting cost-effectiveness acceptability curves: an example using data from a trial of management strategies for atrial fibrillation. BMC Health Services Research, 6(1), 1. • Gallagher, H. M., Rabian, B. A., & McCloskey, M. S. (2004). A brief group cognitive-behavioral intervention for social phobia in childhood. Journal of Anxiety disorders, 18(4), 459-479. • Ginsburg, G. S., & Drake, K. L. (2002). School-based treatment for anxious African-American adolescents: A controlled pilot study. Journal of the American Academy of Child & Adolescent Psychiatry, 41(7), 768-775. • Ginsburg, G. S., Kendall, P. C., Sakolsky, D., Compton, S. N., Piacentini, J., Albano, A. M., . . . Rynn, M. A. (2011). Remission after acute treatment in children and adolescents with anxiety disorders: findings from the CAMS. Journal of Consulting and Clinical Psychology, 79(6), 806-813. • Guy, W. Clinical Global Impressions In: ECDEU Assessment Manual for Psychopharmacology. 1976. Rockville, MD: US Department of Health, Education, and Welfare, 217-222. • Hudson, J. L., Newall, C., Rapee, R. M., Lyneham, H. J., Schniering, C. C., Wuthrich, V. M., . . . Gar, N. S. (2014). The impact of brief parental anxiety management on child anxiety treatment outcomes: A controlled trial. Journal of Clinical Child & Adolescent Psychology, 43(3), 370-380. • Hudson, J. L., & Rapee, R. M. (2001). Parent-child interactions and anxiety disorders: an observational study. Behaviour Research and Therapy, 39(12), 1411-1427. doi:10.1016/s0005-7967(00)00107-8 • Hudson, J. L., & Rapee, R. M. (2004). From Anxious Temperament to Disorder: An Etiological Model. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 51-74). New York, NY, US: Guilford Press. • Hudson, J. L., Rapee, R. M., Deveney, C., Schniering, C. A., Lyneham, H. J., & Bovopoulos, N. (2009). Cognitive-behavioral treatment versus an active control for children and adolescents with anxiety disorders: a randomized trial. Journal of the American Academy of Child & Adolescent Psychiatry, 48(5), 533-544. • Husereau, D., Drummond, M., Petrou, S., Carswell, C., Moher, D., Greenberg, D., . . . Loder, E. (2013). Consolidated health economic evaluation reporting standards (CHEERS) statement. Cost Effectiveness and Resource Allocation, 11(1), 1. • James, A. C., James, G., Cowdrey, F. A., Soler, A., & Choke, A. (2013). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev, 6. • Kendall, P. C., & Hedtke, K. A. (2006). Cognitive-behavioral therapy for anxious children: Therapist manual: Workbook Publishing Ardmore, PA. • Lyneham, H., Abbott, M., Wignall, A., & Rapee, R. M. (2003). The cool kids family program - therapist manual. Sydney, Australia. • Maccoby, E. E. (1992). The role of parents in the socialization of children: An historical overview. Developmental Psychology, 28(6), 1006. • Machin, D., Campbell, M. J., Fayers, P. M., & Pinol, A. P. Y. (1997). Sample Size Tables For Clinical Studies.(2nd edn). Blackwell Science Ltd., Oxford. • McManus, F., Clark, G., Muse, K., & Shafran, R. (2015). Case-series evaluating a transdiagnostic cognitive-behavioural treatment for co-occurring anxiety disorders. Behavioural and cognitive psychotherapy, 43(6), 744-758. • Moore, P. S., Whaley, S. E., & Sigman, M. (2004). Interactions between mothers and children: impacts of maternal and child anxiety. Journal of Abnormal Psychology, 113(3), 471. • Murray, L., Lau, P. Y., Arteche, A., Creswell, C., Russ, S., Della Zoppa, L., . . . Cooper, P. J. (2012). Parenting by anxious mothers: effects of disorder subtype, context, and child characteristics. Journal of Child Psychology and Psychiatry, 53(2), 188-196. doi:10.1111/j.1469-7610.2011.02473.x • Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T. (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical Psychology Review, 40, 91-110. • NICE. (2013). National Institute for Health and Care Excellence. Guide to the methods of technology appraisal. https://www.nice.org.uk/process/pmg9/resources/guide-to-the-methods-of-technology-appraisal-2013-pdf-2007975843781. • Petrou, S., & Gray, A. (2011). Economic evaluation alongside randomised controlled trials: design, conduct, analysis, and reporting. British Medical Journal, 342, d1548. • Piacentini, J., Bennett, S., Compton, S. N., Kendall, P. C., Birmaher, B., Albano, A. M., . . . Ginsburg, G. (2014). 24-and 36-week outcomes for the Child/Adolescent Anxiety Multimodal Study (CAMS). Journal of the American Academy of Child & Adolescent Psychiatry, 53(3), 297-310. • Schleider, J. L., Ginsburg, G. S., Keeton, C. P., Weisz, J. R., Birmaher, B., Kendall, P. C., . . . Walkup, J. T. (2015). Parental psychopathology and treatment outcome for anxious youth: Roles of family functioning and caregiver strain. Journal of Consulting and Clinical Psychology, 83(1), 213-224. doi:10.1037/a0037935 • Settipani, A., O'Neil, A., Podell, L., Beidas, S., & Kendall, P. C. (2013). Youth anxiety and parent factors over time: Directionality of change among youth treated for anxiety. Journal of Clinical Child and Adolescent Psychology, 42(1), 9-21. doi:10.1080/15374416.2012.719459 • Silverman, W. K., & Albano, A. M. (1996). Anxiety Disorders Interview Schedule for DSM-IV.: Parent interview schedule (Vol. 1): Oxford University Press. • Silverman, W. K., Kurtines, W. M., Jaccard, J., & Pina, A. A. (2009). Directionality of change in youth anxiety treatment involving parents: an initial examination. Journal of Consulting and Clinical Psychology, 77(3), 474. • Simon, E., Dirksen, C., Bögels, S., & Bodden, D. (2012). Cost-effectiveness of child-focused and parent-focused interventions in a child anxiety prevention program. Journal of Anxiety Disorders, 26(2), 287-296. • Tilford, J. M., Payakachat, N., Kuhlthau, K. A., Pyne, J. M., Kovacs, E., Bellando, J., . . . Frye, R. E. (2015). Treatment for sleep problems in children with autism and caregiver spillover effects. Journal of Autism and Developmental Disorders, 45(11), 3613-3623. • Tubeuf, S., & Guthmuller, S. (2017). Economic evaluation of family-based therapies for children and adolescents: what do we know? Global & Regional Health Technology Assessment, 4(1), grhta. 5000272. • Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., . . . Waslick, B. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359(26), 2753-2766. • Weinstein, M. C., Torrance, G., & McGuire, A. (2009). QALYs: the basics. Value in Health, 12, S5-S9. • Wille, N., Badia, X., Bonsel, G., Burström, K., Cavrini, G., Devlin, N., . . . Herdman, M. (2010). Development of the EQ-5D-Y: a child-friendly version of the EQ-5D. Quality of Life Research, 19(6), 875-886. • Woodward, L. J., & Fergusson, D. M. (2001). Life course outcomes of young people with anxiety disorders in adolescence. Journal of the American Academy of Child & Adolescent Psychiatry, 40(9), 1086-1093. • Zou, G. (2004). A modified poisson regression approach to prospective studies with binary data. American Journal of Epidemiology, 159(7), 702-706.

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