Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Follow-Up

Abstract Objective To report on the 32-week outcome of the Brief Behavioral Therapy (BBT) for Pediatric Anxiety and Depression in Primary Care clinical trial. Method 185 youth aged 8-17 with anxiety and/or depression identified through 9 pediatric primary care (PPC) settings in San Diego and Pittsburgh were randomized to receive Assisted Referral to Care (ARC) or up to 12 sessions of BBT over 16 weeks. The primary outcome was clinical response across anxiety and depression, defined as a Clinical Global Impressions-Improvement Score ≤ 2. Secondary outcomes included interview-rated functioning, depression, and anxiety. Here, we report on outcomes at 32 weeks after randomization. All analyses with primary outcomes are corrected for multiple comparisons utilizing the False Discovery Rate technique. Results At 32 weeks, BBT was superior to ARC with respect to response (67.5% vs. 43.1%, q=0.03, NNT=5) and functioning ( d =0.49, q=0.04). BBT was superior to ARC with respect to its impact on anxiety ( f =0.21) but not depressive symptoms ( f =0.05). These findings persisted after controlling for the number of sessions received. Ethnicity moderated the impact of BBT on outcome, (NNT for Hispanic youth=2), due to a much lower response rate to ARC in Hispanics than in non-Hispanic youth (16.7% vs. 49.2%, p=0.04). Conclusion BBT is a promising intervention that can be effectively delivered in PPC and may be particularly effective for Hispanic patients. Further work is indicated to improve its impact on depressive symptoms and to test BBT against other treatments delivered in pediatric primary care.