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

Autor: Roz Shafran, Emma McIntosh, Mara Violato, Cathy Creswell, Lucy Willetts, Peter J. Cooper, Susan Cruddace, Stephen Gerry, Lynne Murray, Alan Stein
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Adult
Male
Pediatrics
medicine.medical_specialty
parent–child interaction
Cost effectiveness
Cost-Benefit Analysis
Psychological intervention
Mothers
Context (language use)
law.invention
03 medical and health sciences
0302 clinical medicine
Child of Impaired Parents
Randomized controlled trial
law
Outcome Assessment
Health Care
Developmental and Educational Psychology
medicine
Humans
0501 psychology and cognitive sciences
Child
Cognitive Behavioral Therapy
cognitive behaviour therapy
mother
05 social sciences
Original Articles
anxiety
medicine.disease
Anxiety Disorders
Mother-Child Relations
3. Good health
Quality-adjusted life year
Psychiatry and Mental health
Pediatrics
Perinatology and Child Health
Anxiety
Female
Original Article
Maternal anxiety
medicine.symptom
Psychology
030217 neurology & neurosurgery
Anxiety disorder
050104 developmental & child psychology
Zdroj: Journal of Child Psychology and Psychiatry, and Allied Disciplines
ISSN: 1469-7610
0021-9630
Popis: 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.
Databáze: OpenAIRE
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