Predictors and moderators of outcome in child and adolescent anxiety and depression: A systematic review of psychological treatment studies.
Toril Sørheim Nilsen (corresponding athor: ), Martin Eisemann, Siv Kvernmo, MD,
Appendix: Details concerning the literature search process
Figure 1 presents the process of searching and selecting relevant studies for the present review.
Search: To identify relevant published studies for inclusion in this review, literature searches were completed using the ISI Web, PubMed, Medline (1985 through week 1 March 2011), PsycINFO (1967 through week 1 March 2011). For the four databases ISI Web, Pub Med, Medline and PsycINFO literature searches, four key terms related to diagnosis (“anxiety disorder*” or ”depression” or ”emotional disorder*” or “internalizing disorder”) were paired with each of six key terms related to treatment (“predictor* AND treatment outcome” or “moderator *AND treatment outcome” or “mechanism* of change AND treatment outcome” or “treatment outcome” or “treatment”), all paired with “Child* Youth* Adolescent*”. Publications in English, the Scandinavian languages and in Spanish are assessed. The search terms combined in the four databases yielded 6788 hits. For the PubMed and ISI Web databases weekly updates of relevant studies were automatically e-mailed to the first author, but did not result in the inclusion of any new studies after the final searches in March 2011. Figure 1 displays a flowchart of the number of studies assessed for the present review. For the PubMed and ISI Web databases weekly updates of relevant studies were automatically e-mailed to the first author, but no new studies were encountered after the final searches in March 2011.
Step 1: The first author scanned through the titles and abstracts of 2639 articles for the combination of search terms with anxiety disorders (including duplicates), 3629 articles for the combination with “depression”, 361 articles on “emotional disorders” and 159 articles for the combination with “internalizing disorders”. Studies with titles reflecting the search terms were selected for step 2. The studies encountered by the search terms “Emotional disorders” or “Internalizing disorders” were the same studies encountered by the search terms “anxiety disorders” or “depression”. No treatment trials of both anxiety and depression were identified. Thus, the succeeding search process (Step 2 and forward) was concentrated around the two categories of “Anxiety” and “Depression”.
Also in Step 1, the first author scanned the reference lists of prior reviews and meta- analysis. For the topic of depression, the reference lists of one meta- analysis [1] and three reviews [2-6] yielded 19 studies that were further assessed at step 2. Search through the reference lists of one meta- analysis [7] and eight reviews on anxiety [8-15] yielded 29 studies that were further assessed at Step 2.
Step 2: The abstracts, and when indicated the result sections, of studies included in step 2 were read by the first author, and the studies were scrutinized according to the inclusion/exclusion criteria presented below. Studies meeting the criteria were included in the present review.
Step 3: The majority of studies assessed in Step 3, met nearly all inclusion criteria. These were studies that were read more in depth to assess whether they met the inclusion criteria. The primary inclusion criteria was that studies needed to have performed and reported statistical examinations of child and adolescent baseline characteristics as predictors and/or moderators of treatment outcome. Still, in order to reduce the methodological plurality and to ease comparison of results between studies, nine other inclusion criteria were set. Nine anxiety studies meeting the main criteria of predictor and moderator examination were excluded due to n < 50, while two anxiety studies had n < 50 and did not have anxiety symptoms or diagnostic status as outcome measures, one additional study had n < 50 and reported long- term follow – up outcomes only (see Table A1 for list of studies). For the depression studies most studies were excluded for several reasons. A total of thirteen depression studies that were excluded in the third step were combination studies of CBT and medication (see Table A2 for a list of studies).
Further comment to the search process: The hit factor for all four search terms related to diagnosis (Anxiety disorder, Emotional disorder, Internalizing disorder, and Depression) is presented for Step 1. The numbers within the boxes are based on record- notes of the first author during the search process. Due to duplicates encountered in the search process, the numbers presented in Step 1 and 2, can be considered as estimates of the total number of studies screened within each category at those stages of the search process. The numbers presented for Step 3 is based on thorough record keeping (see Tables A1and A2 of the Supplemental material).
All included studies were in English, although we included the Scandinavian languages and Spanish in the predefined search limits of the PubMed searches (limits activated were: Humans, Clinical Trial, Meta-Analysis, Randomized Controlled Trial, Review, Classical Article, Clinical Conference, English, Spanish, Danish, Norwegian, Swedish, All Child: 0-18 years). For the PsychInfo, Medline and ISI Web of Knowledge databases, no predefined search limits were activated. A few articles in Spanish, one article in Swedish and a few articles in Norwegian were assessed at Step 2 in the process, but did not meet inclusion criteria. The number of different language articles might have been larger if we had performed searches in the before- mentioned languages.
Exclusion/inclusion criteria:
In the present review, the following criteria were used to select studies: The study must 1) conduct and present a statistical examination of child pre-treatment characteristics as possible nonspecific predictors or moderators of treatment outcome. In addition we included only predictors and moderators that have been examined in more than one study in order to increase confidence in specific findings and to be able to compare the results of studies. 2) be a treatment study with randomized controlled designs or controlled designs. Prevention studies are excluded, 3) be published in peer-reviewed journals from 1985 onwards, 4) target psychological treatments. Pharmacotherapy or combination studies are excluded, 5) be conducted in an outpatient setting, i.e. studies of inpatient treatment were excluded, 6) include a minimum of 50 subjects in post treatment analysis, 7) the study population must consist of children and/or adolescents 4 - 18 years of age, 8) include children and adolescents with a primary diagnosis of anxiety or depression with or without comorbid conditions. All diagnostic categories pertaining to Anxiety disorders according to DSM IV and ICD 10 criteria were included, excluding Post Traumatic Stress Disorder (PTSD) and Obsessive Compulsive Disorder (OCD). All diagnostic categories for unipolar depression according to DSM IV and ICD 10 criteria were included, excluding bipolar depressive disorder, 9) the study must report an outcome measure of anxiety and/or depression symptoms from multiple informants and/or diagnostic status of anxiety and/or depression, 10) the outcome measures must be conducted post-treatment. Studies reporting follow-up or maintenance outcomes only were excluded.
Table A1: Studies of anxiety treatment studies excluded in phase 3: Reason for exclusion in numerics
Study / Exclusion criteriaAlfano et al. [16] / 4
Barrett [17] / 1
Barrett, Duffy, Dadds and Rapee [18] / 10
Chu and Kendall [19] / 1
Creswell, Schniering and Rapee [20] / 2, 9
Creswell et al. (2008) / 1, 6
Cartwright-Hatton et al. [21] / 1
Dadds et al. [22] / 2
De Jong, Andrea and Muris [23] / 6, 9
Flannery – Schroeder et al. [24] / 10
Flannery-Schroeder and Kendall [25] / 1
Gar and Hudson [26] / 1, 6
Guberman and Manassis [27] / 1, 9
Hayward et al. [28] / 6
Hughes, Hedtke and Kendall [29] / 1, 9
Kendall [30] / 6
Kendall et al. [31] / 10
Kendall and Treadwell [32] / 1
Khanna and Kendall [33] / 1, 6
Last, Hansen and Franco [34] / 6
Layne et al. [35] / 6
Lau et al. [36] / 6
Manassis et al. [37] / 10
Mendlowitz et al. [38] / 1
Miller, Barrett, Noble and Hampe [39] / 1
Monga et al.[40] / 6
Muris et al. [41] / 6
Pan, Huey and Hernandez [42] / 10
Podell and Kendall [43] / 1, 6
Silverman et al. [44] / 1
Silverman et al. [45] / 1
Silvermann et al. [46] / 1
Southam-Gerow et al. [47] / 1
Spence et al. [48] / 1
St-Jacques, Bouchard and Bélanger [49] / 6
Suveg, Hudson, et al. [50] / 9
Suveg et al. [51] / 6
Svensson, Larsson and Ost [52] / 1
Treadwell and Kendall [53] / 1
Victor et al [54] / 1
Walkup et al. [55] / 1, 4
Waters et al [56] / 6, 9
Wood et al. [57] / 1, 6
Wood, McLeod, Piacentini and Sigman [58] / 6, 10
Table A2: Studies of depression treatment studies excluded in phase 3: Reason for exclusion in numerics
Study / Exclusion criteriaAsarnow, Scott and Mintz [59] / 1, 2, 8
Ackerson, Scogin, McKendree-Smith and Lyman [60] / 1, 6, 8
Brent et al. [61] / 1
Butler et al. [62] / 1
Canavera et al. [63] / 8
Clarke et al. [64] / 6
Clarke et al. [65] / 1, 2, 8
Clarke et al. [66] / 1, 2, 8
Clarke et al. [67] / 1
Clarke et al. [68] / 1
Curry, Wells, Lochman, Craighead and Nagy [69] / 1, 6
De Cuyper, Timbremont, Braet, De Backer, and Wullaert [70] / 1, 8
Diamond, Reis, Diamond, Siqueland, and Isaacs [71] / 1, 6
Fine, Forth, Gilbert and Haley [72] / 1
Fine et al. [73] / 2, 6
Forbes et al. [74] / 2,6, 4
Goodyer et al. [75] / 2, 9, 10
Goodyer et al. [76] / 2, 10
Goodyer et al. [77] / 1, 4
Hoberman et al. [78] / 2, 6
Kahn, Kehle, Jenson and Clark [79] / 1
Karlsson et al. [80] / 2, 4, 9
Kaufman, Rohde, Seeley, Clarke and Stice [81] / 1
Kerfoot, Harrington, Harrington, Rogers and Verduyn [82] / 1
Kovacs et al. [83] / 2, 10
Kroll et al. [84] / 1, 2, 6, 9, 10
Liddle and Spence [85] / 1, 6, 8
Melvin et al. [86] / 1
Mufson, Weissman, Moreau and Garfinkel [87] / 1, 6
Muratori et al. [88] / 1, 10
Nemeroff et al. [89] / 4
Nelson, Barnard and Cain [90] / 1,6
Ngo et al. [91] / 4
Reed [92] / 6
Reynolds and Coats [93] / 1, 6
Roberts, Kane, Thomson, Bishop and Hart [94] / 1, 2, 8
Rohde et al. [95] / 9
Rossello & Bernal [96] / 1
Rossello et al. [97] / 1
Sanford et al. [98] / 1, 6
Stark, Reynolds and Kaslow [99] / 1, 6
Vostanis, Feehan, Grattan and Bickerton [100] / 6, 10
Vostanis, Feehan, Grattan and Bickerton [101] / 1
Young et al. [102] / 2, 6
Weisz et al. [103] / 6, 8
Weisz et al. [104] / 1
Wilkinson et al. [105] / 4, 9
Wood et al. [106] / 1
Treatment of Resistant Depression in Adolescents (TORDIA)
Emslie et al. [107] / 4
Shamseddeen et al. [108] / 4
The Treatment for Adolescent with Depression Study (TADS)
Becker-Weidman et al. [109] / 4
Curry et al. [110] / 4
Curry et al. [111] / 4, 10
Feeny et al. [112] / 4
Jacobs et al. [113] / 4
Jacobs et al. [114] / 4
Lewis et al. [115] / 4
Lewis et al. [116] / 4
Vitiello et al. [117] / 4, 9
Longterm follow-up papers of included studies
Birmaher et al. [118] / 10
Brent et al. [119] / 9, 10
Renaud et al. [120] / 10
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