The Role of Comorbid Depression in Youth Anxiety Treatment Outcomes
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ORIGINAL ARTICLE
The Role of Comorbid Depression in Youth Anxiety Treatment Outcomes Hannah E. Frank1,2 · Madison K. Titone1,3 · Elana R. Kagan1,4 · Lauren B. Alloy1 · Philip C. Kendall1 Accepted: 9 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Findings have been mixed regarding the relationship between comorbid depression and anxiety and treatment outcomes for anxious youth. The current study compared a sample of anxious youth with a comorbid depressive disorder (n = 20) and those without comorbid depression (n = 137). All participants received 16 weekly sessions of Coping Cat and completed measures assessing anxiety/depression severity, impairment, and functioning at pretreatment and posttreatment. Results indicated that anxiety-focused CBT is efficacious for anxious youth with and without comorbid depressive disorders, with a higher rate of symptom improvement for youth with comorbid depression during treatment. However, comorbid depression was associated with higher severity at baseline and after treatment. Thus, despite the higher rate of symptom improvement, anxious youth with comorbid depression may benefit from additional treatment to address remaining symptoms. Keywords Anxiety · Depression · Youth · Cognitive behavioral therapy
Introduction Depression and anxiety are among the most common mental health disorders in youth [1]. Considered separately, anxiety disorders are present in 10–20% of youth [1]. Similarly, depression has a lifetime prevalence of approximately 20% by late adolescence, and 2–6% prevalence at any given time [2]. Among youth diagnosed with an anxiety disorder, 25–28% also exhibit a comorbid depressive disorder [1]. Several models have been proposed to explain the high cooccurrence of the two disorders, which likely arises through one of several possible pathways [3, 4]. With regard to baseline symptoms, youth with comorbid anxiety and depression have been shown to have lower global functioning, greater * Hannah E. Frank [email protected] 1
Department of Psychology, Temple University, Philadelphia, PA, USA
2
Present Address: Alpert Medical School of Brown University and Bradley Hospital, 1011 Veterans Memorial Parkway, Riverside, RI 02915, USA
3
Present Address: VASDHD/UCSD, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
4
Present Address: Kennedy Krieger Institute, 720 Aliceanna St, Baltimore, MD 21202, USA
impairment, poorer family functioning, higher levels of negative affect, and poorer emotion regulation than youth with either disorder alone [5–9]. These indicators of greater severity across several measures are well-documented, but the role of comorbid conditions in predicting anxiety treatment outcomes remains less clear. Although cognitive behavioral therapy (CBT) for anxiety is considered a well-established treatment [10], approximately one-third of youth do not respond to CBT for anxiety. Understanding the role of comorbid conditions on treatment outcomes may provide insights into why some youth do
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