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Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Randomized Clinical Trial
Weersing VR, Brent DA, Rozenman MS, Gonzalez A, Jeffreys M, Dickerson JF, Lynch FL, Porta G and Iyengar S
JAMA Psychiatry. Published online 

Anxiety and depression affect 30% of youth but are markedly undertreated compared with other mental disorders, especially in Hispanic populations. A study by Dr. David Brent examined whether a pediatrics-based behavioral intervention targeting anxiety and depression improves clinical outcome compared with referral to outpatient community mental health care.

Dr. Brent collaborated with colleagues at the University of Pittsburgh and the University of California San Diego to conduct a two-site randomized clinical trial of 185 youth who met DSM-IV criteria for full or probable diagnoses of separation anxiety disorder, generalized anxiety disorder, social phobia, major depression, dysthymic disorder, and/or minor depression. The trial used masked outcome assessment conducted between brief behavioral therapy (BBT) and assisted referral to care (ARC). The BBT consisted of 8 to 12 weekly 45-minute sessions of behavioral therapy delivered in pediatric clinics by master’s-level clinicians. The ARC families received personalized referrals to mental health care and check-in calls to support accessing care from master’s-level coordinators.

Youths in the BBT group, compared with those in the ARC group had significantly higher rates of clinical improvement, greater reductions in symptoms, and better functioning. Ethnicity moderated outcomes, with Hispanic youth having substantially stronger response to BBT (76.5%) than ARC (7.1%). Findings from this study indicate that a pediatric-based brief behavioral intervention for anxiety and depression is associated with benefits superior to those of assisted referral to outpatient mental health care. Effects were especially strong for Hispanic participants, suggesting that the protocol may be a useful tool in addressing ethnic disparities in care. 

Contributors:

David A. Brent, MD and Giovanna Porta, MS (Department of Psychiatry, University of Pittsburgh School of Medicine)

Satish Iyengar, PhD (Department of Statistics, University of Pittsburgh)

V. Robin Weersing, PhD and Megan Jeffreys, MS  (Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California San Diego; Department of Psychology, San Diego State University)

Michelle S. Rozenman, PhD (Division of Child & Adolescent Psychiatry, UCLA Semel Institute for Neuroscience & Human Behavior)

Araceli Gonzalez, PhD (Department of Psychology, California State University, Long Beach)

John F. Dickerson, PhD and Frances L. Lynch, PhD (Center for Health Research, Kaiser Permanente Northwest)

This article appears in the journal JAMA Psychiatry. Click here to view the abstract.