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 (a) maternal anxiety disorders or (b) mother-child interactions. METHODS Two hundred and eleven 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 (a) child-focused CBT with nonspecific control interventions (CCBT+Con), (b) CCBT with CBT for the maternal anxiety disorder (CCBT+MCBT), or (c) 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 nonspecific 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 = .29; CCBT+MCI vs. CCBT+Con: 0.02 (95% CI: -0.05, -0.09), p = .54). CCBT+MCI was associated with nonsignificantly higher costs than CCBT (mean difference: £154 (95% CI: -£1,239, £1,547), p = .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.

中文翻译：

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在母体焦虑症背景下治疗儿童焦虑症的随机对照试验：临床和成本效益结果。

背景技术这项研究评估了通过增加针对（a）孕产妇焦虑症或（b）母婴互动的治疗，是否可以改善CBT对母体焦虑症背景下的儿童焦虑症的临床和经济结果。方法211名患有原发性焦虑症的儿童（7-12岁，英国白人占85％，女性52％），其母亲也患有目前的焦虑症，被随机分配接受（a）以儿童为中心的CBT（非特异性对照）干预措施（CCBT + Con），（b）CCBT与CBT结合治疗母体焦虑症（CCBT + MCBT），或（c）CCBT结合针对母婴互动的干预措施（CCBT + MCI）。从社会角度分析了成本－效用分析，方法是使用母亲/儿童合并的质量调整生命年（QALYs）。[试用注册：https：//doi.org/10。1186 / isrctn19762288]。结果与非特异性对照相比，MCBT与母亲焦虑症的立即减少相关。但是，在孩子也接受了CCBT后，CCBT + MCI和CCBT + Con组的产妇结局得到改善，而CCBT + MCBT不再占优势。就治疗后的儿童焦虑症[主要结局]而言，CCBT + MCBT和CCBT + MCI均未赋予其优于CCBT + Con的益处（ad RR：1.22（95％CI：0.88，1.67），p = 0.23；调整） RR：1.21（95％CI：0.88，1.65），p = 0.24）或总体改善等级（adj RR：1.25（95％CI：0.99，1.57），p = .06;可调RR：1.18（95 ％CI：0.93，1.50），p = .17）或六个月和十二个月后。两组之间在主要经济结果指标上均未发现显着差异（儿童/母亲QALY的平均均值差异：CCBT + MCBT与CCBT + Con：-0.04（95％CI：-0.12，0.04），p = .29；CCBT + MCI与CCBT + Con：0.02（95％CI：-0.05，-0.09），p = .54）。CCBT + MCI的成本比CCBT高得多（均值差：£154（95％CI：-£1,239，£1,547），p = .83），但是，考虑到采样不确定性，它可能具有成本效益与单独的CCBT相比。结论儿童和他们的母亲在各治疗部门均取得了良好的治疗效果。没有证据表明用CBT补充CCBT来治疗母体焦虑症或专注于母婴相互作用的治疗具有明显的临床益处，但是添加MCI（而非MCBT）可能具有成本效益。考虑到采样的不确定性，与仅CCBT相比，它可能具有成本效益。结论儿童和他们的母亲在各治疗部门均取得了良好的治疗效果。没有证据表明用CBT补充CCBT来治疗母体焦虑症或专注于母婴相互作用的治疗具有明显的临床益处，但是添加MCI（而非MCBT）可能具有成本效益。考虑到采样的不确定性，与仅CCBT相比，它可能具有成本效益。结论儿童和他们的母亲在各治疗部门均取得了良好的治疗效果。没有证据表明用CBT补充CCBT来治疗母体焦虑症或专注于母婴相互作用的治疗具有明显的临床益处，但是添加MCI（而非MCBT）可能具有成本效益。