Teenagers Approaching Adulthood Tend to Stop Treating their Anxiety

What’s happening – Do youth and adolescents with anxiety disorder consistently use mental health services as they enter adulthood? Generally not, according to a new study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) which found that only about one-third of young people reported consistent use of services into early adulthood.

Researchers aimed to investigate the rates and predictors of long-term service use as well as the link between anxiety diagnosis and service use over time. Service use data were available for 318 children and adolescents who received anxiety treatment at ages 7- to 17-years-old as part of the Child/Adolescent Anxiety Multimodal Study (CAMS) study. CAMS was a six-year, six-site RCT in which children with anxiety disorders were assigned to one of four treatment groups: cognitive-behavioral therapy (CBT), sertraline (SRT), combination (COMB), or placebo.

Looking at long-term service use, 65.1% of participants endorsed receiving some form of anxiety treatment during the follow-up period while just 35.2% reported consistent use of services. The authors described the need to consider anxiety disorders chronic health conditions that require long-term treatment.

The details – Read the full study by Peris et al in JAACAP.

Why it’s complicated – Child and adolescent anxiety disorders are not generally approached as chronic conditions but Peris and coauthors argue they should be. Further, relapse is common in this population, making the need for improved data sets and treatments crucial.

  • In a 2018 study that also used data from the CAMS study, researchers found that in youth who received 12 weeks of treatment for anxiety (CBT, SRT, or COMB), 22% stayed in remission, 30% remained chronically ill, and 48% relapsed. The type of treatment used did not affect the outcomes. The authors suggested the need for better treatments that will prevent relapses and improve outcomes for this population.
  • An APA article reviews the prevalence of child and adolescent anxiety, the influence of parents, treatment strategies and outcomes, and the possibility of success using tailored treatments.
  • A team of researchers presented an international consensus statement in July 2020 aimed at promoting consistency in selecting and reporting outcome measures for clinical trials for child and adolescent anxiety disorders. The goals are to guide future research so that data sharing is improved when communicating what has been measured and reported in the research.

The conversation

  • @APAPsychiatric (American Psychiatric Association) tweeted a link to their report on the study, which was retweeted by JAACAP, saying “Anxiety is a chronic condition, yet only a little more than a third of young people who had received early evidence-based treatment for anxiety reported consistent use of services into early adulthood, according to a study in the @JAACAP.”
  • @dr_pines (Dr Richard Pines) replied to this tweet, saying “Very true. My millennial patients often seek out treatment for anxiety. Respond well to treatment. Then stop treatment because they feel better and come back later having regressed. We have to continue our attempts to educate this population.”

In practice – More from AACAP including how to identify and predict mental disorders in children. How to use DBT for teen anxiety.

Why Depression in Youth Matters: New Links to Later-Life Illness and Premature Death

What’s happening – Children and adolescents diagnosed with depression have an increased risk of developing somatic illnesses later in life, as well as premature death, according to a study published in JAMA Psychiatry. Researchers found an association between early depression diagnosis and increased risk of 66 out of 69 medical conditions studied, including sleep disorders, type 2 diabetes, viral hepatitis, and kidney and liver diseases. Those with depression had a six-fold higher risk of premature death, and girls with depression were 14 times more likely to experience injury due to self-harm compared to those without youth depression.

Researchers used data from Swedish national registers and followed nearly 1.5 million individuals, of whom about 37,000 were diagnosed with depression between ages 5 and 19. Subjects were between 17- and 31-years-old when the study concluded. The authors wrote that more research must be done to determine whether there is a causal relationship between depression at a young age and later health problems, and they suggested that clinicians look for other physical diseases following childhood or adolescent depression.

The details – Read the full study by Leone et al in JAMA Psychiatry.

The perspectives

Why it’s complicated – The authors highlighted the need for future research to investigate whether youth depression leads to physical illness or if there is a common cause for both issues. Investigating links between mental and physical illness is an ongoing and complex area of research.

  • In a cohort study of nearly 87,000 children and adults with attention-deficit/hyperactivity disorder (ADHD), researchers found an association between psychiatric comorbidity and an increased risk of premature death.
  • Childhood-onset inflammatory bowel disease (IBD) was associated with a risk of psychiatric disorders and suicide attempts in a separate cohort study published in JAMA Pediatrics. The authors suggested that long-term psychological support be given to patients with childhood-onset IBD.
  • People with depression have a significantly shorter life expectancy, according to a study published in the Journal of Affective Disorders. The reduced life expectancy was 14 years for men and 10.1 years for women, with physical illness as the main cause of death, but suicide and unintentional injury were also reported causes.
  • Researchers looked at mortality in terms of depression before and after chronic physical illnesses, finding a high mortality risk when depression comes before a somatic illness. Depression before an illness was associated with higher mortality risks for 13 of 19 conditions studied, and highest for liver disease, metastatic solid tumor, and heart attack.

The conversation

  • @karolinskainst (Karolinska Institutet, the Swedish medical University with which six of the JAMA Psychiatry study’s authors are affiliated) tweeted, “Depressed children and teenagers have an increased risk of suffering from premature death and up to 66 diseases later in life” and linked to a press release about the study.
  • @marical1702 (doctoral student and lead author Marica Leone) tweeted “Very excited to share my first paper!” along with a thread of key findings from the study.
  • @Sarah_E_Bergen (senior researcher at the Karolinska Institutet and last author on the study) retweeted @marical1702’s post, saying “So proud of my amazing doctoral student, Marica Leone! Not often that a first publication gets a press release and write up in the New York Times!”

Comorbid PTSD and Depression Finally Studied in Women: Results Show Poor Outlook

What’s happening – Women who have both PTSD and depression symptoms can have a nearly four-fold risk of death compared to women without these disorders, according to a recent study. Using data from the Nurses’ Health Study II, collected from 51,602 female nurses over 9 years, researchers found that high PTSD symptoms combined with symptoms of depression greatly increased the risk of a woman’s death from cardiovascular disease, diabetes, injury, suicide, and other causes.

The data also associated lower BMI, physical activity, being a nonsmoker, and being married with a decreased risk of death. The authors, therefore, suggest that treatment of comorbid PTSD and depression in this population, along with efforts to improve health behaviors, could help reduce the risk of mortality.

The details – Read the full study by Roberts, et al, in JAMA Network Open

Why it’s noteworthy – The link between PTSD and increased risk of mortality has been researched “almost exclusively” in male veterans, and this the first large study to examine PTSD and depression in female civilians, the authors share in their paper. They also note that women have twice the lifetime prevalence of PTSD than men, twice the risk of developing PTSD after a trauma than men, and that depression (which often co-occurs with PTSD) is twice as prevalent in women than men. These statistics highlight the importance of studying the association between PTSD and comorbid depression and mortality in women.

  • The authors noted one previous study that examined the association between PTSD and mortality in civilian women, which used Danish medical records.
  • Studies of veterans with PTSD have looked at links between cardiac issues and mortality, including the role of specific biomarkers.
  • Research on PTSD and autoimmune disease found that trauma exposure and PTSD were strongly associated with increased risk of incident systemic lupus erythematosus in women. Andrea L Roberts, PhD, was the lead author for both this lupus study and the noted PTSD and depression study, which she discusses in this week’s Psy-Q trivia challenge below.

Psy-Q

Should clinicians be concerned about mortality when a patient presents with comorbid PTSD and depression?

Get the answer

The conversation

  • Canada’s @OSIResearch, The MacDonald Franklin OSI Research Centre that focuses on the mental health of veterans and military members, tweeted a link to the article and highlighted a quote from the article about the potential of reducing the mortality risk for women through treatment.
  • @MPebole, behavioral scientist and doctoral student Michelle Pebole, linked to the study, tweeting “Really excited about more work focusing on women with PTSD and health behaviors- improving behaviors (PA) may decrease mortality.”
  • @RealHealthMag (Real Health Magazine) asks, “Can PTSD With Depression Raise Premature Mortality Among Women?” and links to their report on the study.

In practicePsychedelics have been offered up as a potential treatment for PTSD and depression. Clinicians often also must differentiate between depression and burnout. Here’s how botulinum toxin may help certain patients living with depression.

Last Updated: May 24, 2021