Anxiety disorders are one of the most common mental illnesses in children and are associated with symptoms causing impairment and poor functioning. Effective early treatment of anxiety may reduce its negative impact and reduce its persistence into young adulthood. The antidepressant class selective serotonin reuptake inhibitors (SSRIs) are recommended as the first line medication treatment for children with functional impairing anxiety disorders, based on randomized controlled trial evidence. It is unknown whether children with anxiety initiate prescription medication concordant with guidelines. The burden of serious adverse outcomes in children with anxiety is also unknown. Given that the combination of cognitive behavioral therapy and SSRIs has been shown to offer an advantage over SSRIs alone and psychotherapy alone in treating children with moderate to severe anxiety, it is hypothesized that children receiving combination therapy may experience reduced serious adverse outcomes compared to children on mono-therapy. Increased contact with a healthcare provider (i.e. children on combination therapy) may also result in improved medication adherence. The proposed study will describe prescription medication utilization for anxiety, how long the medications are taken, and the frequency in which psychotherapy is used surrounding medication initiation in children (3-17 years) with a non-OCD anxiety diagnosis from 2004-2013 (Aim 1). The rate of serious adverse outcomes in children with anxiety and whether serious adverse outcomes vary by treatment type: combination therapy (SSRI + psychotherapy) vs. SSRI mono-therapy and psychotherapy mono-therapy, and whether results differ by co-morbid depression status will be estimated (Aim 2). The serious adverse outcomes evaluated will include treated self-harm events, mental health related hospitalizations, and emergency room visits. Lastly the proposed study will estimate SSRI adherence in children with anxiety and whether adherence varies between children on combination therapy vs. SSRI mono-therapy (Aim 3). The proposed observational study will utilize an administrative claims datasource providing a real world population, adequate sample size, and longitudinal data to effectively and efficiently address the study questions. Results from this study will inform further work and will assist providers, patients, and caregivers in optimizing treatment to minimize the risk of serious adverse outcomes.

Public Health Relevance

Anxiety disorders are prevalent in children but little is known about treatment utilization and the rate at which serious adverse outcomes occur in children with anxiety. The proposed research project will fill these gaps in the literature by describing pharmacotherapy and psychotherapy treatment utilization and whether the rates of serious adverse outcomes (treated self-harm events, mental health related hospitalizations, emergency room visits) vary by treatment type. This information will assist providers, patients, and caregivers in the treatment decision-making process and potentially decrease some of the concerning serious adverse outcomes.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (ZMH1)
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Sarampote, Christopher S
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University of North Carolina Chapel Hill
Public Health & Prev Medicine
Schools of Public Health
Chapel Hill
United States
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Bushnell, Greta A; Brookhart, M Alan; Gaynes, Bradley N et al. (2018) Examining Parental Medication Adherence as a Predictor of Child Medication Adherence in Pediatric Anxiety Disorders. Med Care 56:510-519
Bushnell, Greta A; Stürmer, Til; Gaynes, Bradley N et al. (2017) Simultaneous Antidepressant and Benzodiazepine New Use and Subsequent Long-term Benzodiazepine Use in Adults With Depression, United States, 2001-2014. JAMA Psychiatry 74:747-755