Objective

To report on the 32-week outcome of the Brief Behavioral Therapy (BBT) for Pediatric Anxiety and Depression in Primary Care clinical trial.

Method

A total of 185 youths aged 8 to 17 years with anxiety and/or depression identified through 9 pediatric primary care (PPC) settings in San Diego and Pittsburgh were randomized to receive Assisted Referral to Care (ARC) or up to 12 sessions of BBT over 16 weeks. The primary outcome was clinical response across anxiety and depression, defined as a Clinical Global Impressions−Improvement Score of ≤2. Secondary outcomes included interview-rated functioning, depression, and anxiety. Here, we report on outcomes at 32 weeks after randomization. All analyses with primary outcomes are corrected for multiple comparisons using the false discovery rate procedure.

Results

At 32 weeks, BBT was superior to ARC with respect to response (67.5% versus 43.1%, q = 0.03, number needed to treat [NNT] = 5) and functioning (d = 0.49, q = 0.04). BBT was superior to ARC with respect to its impact on anxiety (f = 0.21) but not depressive symptoms (f = 0.05). These findings persisted after controlling for the number of sessions received. Ethnicity moderated the impact of BBT on outcome (NNT for Hispanic youths = 2), because of a much lower response rate to ARC in Hispanic than in non-Hispanic youths (16.7% versus 49.2%, p = 0.04).

Conclusion

BBT is a promising intervention that can be effectively delivered in PPC and may be particularly effective for Hispanic patients. Further work is indicated to improve its impact on depressive symptoms and to test BBT against other treatments delivered in pediatric primary care.

Clinical trial registration information

Brief Cognitive Behavioral Therapy (CBT) for Pediatric Anxiety and Depression in Primary Care; http://clinicaltrials.gov; NCT01147614.

中文翻译：

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初级保健中儿童焦虑和抑郁的简短行为疗法：后续行动。

客观的

报告初级保健临床试验中儿童焦虑和抑郁的简短行为疗法 (BBT) 的 32 周结果。

方法

在圣地亚哥和匹兹堡的 9 个儿科初级保健 (PPC) 机构中，共有 185 名 8 至 17 岁患有焦虑症和/或抑郁症的青少年被随机分配接受辅助转诊 (ARC) 或最多 12 次 BBT 16周。主要结果是焦虑和抑郁的临床反应，定义为≤2 的临床总体印象-改善评分。次要结果包括访谈评定的功能、抑郁和焦虑。在这里，我们报告了随机化后 32 周的结果。使用错误发现率程序对所有具有主要结果的分析进行多重比较校正。

结果

在 32 周时，BBT 在反应（67.5% 对 43.1%，q = 0.03，需要治疗的人数 [NNT] = 5）和功能（ d  = 0.49，q = 0.04）方面优于 ARC 。BBT 就其对焦虑的影响 ( f  = 0.21) 而不是抑郁症状 ( f  = 0.05) 而言优于 ARC。在控制收到的会话数量后，这些发现仍然存在。种族缓和了 BBT 对结果的影响（西班牙裔青年的 NNT = 2），因为西班牙裔青年对 ARC 的反应率远低于非西班牙裔青年（16.7% 对 49.2%，p  = 0.04）。

结论

BBT 是一种很有前途的干预措施，可以在 PPC 中有效实施，并且可能对西班牙裔患者特别有效。需要进一步的工作来改善其对抑郁症状的影响，并测试 BBT 与儿科初级保健中提供的其他治疗方法的对比。

临床试验注册信息

初级保健中儿童焦虑和抑郁的简短认知行为疗法 (CBT)；http://clinicaltrials.gov；NCT01147614。