Abstract
BackgroundThis 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.MethodsTwo 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.ConclusionsGood 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.
Highlights
Anxiety disorders are among the most common psychological disorders in childhood affecting 2.6%– 5.2% of children under the age of 12 years (e.g. Costello, Egger, & Angold, 2004)
Neither Child Cognitive Behaviour Therapy (CCBT)+MCBT nor CCBT+Mother–Child Interaction treatment (MCI) conferred a benefit over CCBT+Con in terms of child anxiety disorder diagnoses post-treatment [primary outcome] (adj RR: 1.22, p = .23; adj RR: 1.21, p = .24, respectively) or global improvement ratings (adj RR: 1.25, p = .06; adj RR: 1.18, p = .17) or six and 12 months later
The study was powered to provide 90% power at the 5% significance level to detect a 30% difference in the primary outcome – that is the proportion of children who recovered from their primary anxiety disorder at the posttreatment assessment in the CCBT+MCI or CCBT+MCBT arms compared to the CCBT+Con arm
Summary
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 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). 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.
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