PMID- 26004142 OWN - NLM STAT- MEDLINE DCOM- 20160218 LR - 20220129 IS - 2046-4924 (Electronic) IS - 1366-5278 (Print) IS - 1366-5278 (Linking) VI - 19 IP - 38 DP - 2015 May TI - Treatment of childhood anxiety disorder in the context of maternal anxiety disorder: a randomised controlled trial and economic analysis. PG - 1-184, vii-viii LID - 10.3310/hta19380 [doi] AB - BACKGROUND: Cognitive-behavioural therapy (CBT) for childhood anxiety disorders is associated with modest outcomes in the context of parental anxiety disorder. OBJECTIVES: This study evaluated whether or not the outcome of CBT for children with anxiety disorders in the context of maternal anxiety disorders is improved by the addition of (i) treatment of maternal anxiety disorders, or (ii) treatment focused on maternal responses. The incremental cost-effectiveness of the additional treatments was also evaluated. DESIGN: Participants were randomised to receive (i) child cognitive-behavioural therapy (CCBT); (ii) CCBT with CBT to target maternal anxiety disorders [CCBT + maternal cognitive-behavioural therapy (MCBT)]; or (iii) CCBT with an intervention to target mother-child interactions (MCIs) (CCBT + MCI). SETTING: A NHS university clinic in Berkshire, UK. PARTICIPANTS: Two hundred and eleven children with a primary anxiety disorder, whose mothers also had an anxiety disorder. INTERVENTIONS: All families received eight sessions of individual CCBT. Mothers in the CCBT + MCBT arm also received eight sessions of CBT targeting their own anxiety disorders. Mothers in the MCI arm received 10 sessions targeting maternal parenting cognitions and behaviours. Non-specific interventions were delivered to balance groups for therapist contact. MAIN OUTCOME MEASURES: Primary clinical outcomes were the child's primary anxiety disorder status and degree of improvement at the end of treatment. Follow-up assessments were conducted at 6 and 12 months. Outcomes in the economic analyses were identified and measured using estimated quality-adjusted life-years (QALYs). QALYS were combined with treatment, health and social care costs and presented within an incremental cost-utility analysis framework with associated uncertainty. RESULTS: MCBT was associated with significant short-term improvement in maternal anxiety; however, after children had received CCBT, group differences were no longer apparent. CCBT + MCI was associated with a reduction in maternal overinvolvement and more confident expectations of the child. However, neither CCBT + MCBT nor CCBT + MCI conferred a significant post-treatment benefit over CCBT in terms of child anxiety disorder diagnoses [adjusted risk ratio (RR) 1.18, 95% confidence interval (CI) 0.87 to 1.62, p = 0.29; adjusted RR CCBT + MCI vs. control: adjusted RR 1.22, 95% CI 0.90 to 1.67, p = 0.20, respectively] or global improvement ratings (adjusted RR 1.25, 95% CI 1.00 to 1.59, p = 0.05; adjusted RR 1.20, 95% CI 0.95 to 1.53, p = 0.13). CCBT + MCI outperformed CCBT on some secondary outcome measures. Furthermore, primary economic analyses suggested that, at commonly accepted thresholds of cost-effectiveness, the probability that CCBT + MCI will be cost-effective in comparison with CCBT (plus non-specific interventions) is about 75%. CONCLUSIONS: Good outcomes were achieved for children and their mothers across treatment conditions. There was no evidence of a benefit to child outcome of supplementing CCBT with either intervention focusing on maternal anxiety disorder or maternal cognitions and behaviours. However, supplementing CCBT with treatment that targeted maternal cognitions and behaviours represented a cost-effective use of resources, although the high percentage of missing data on some economic variables is a shortcoming. Future work should consider whether or not effects of the adjunct interventions are enhanced in particular contexts. The economic findings highlight the utility of considering the use of a broad range of services when evaluating interventions with this client group. TRIAL REGISTRATION: Current Controlled Trials ISRCTN19762288. FUNDING: This trial was funded by the Medical Research Council (MRC) and Berkshire Healthcare Foundation Trust and managed by the National Institute for Health Research (NIHR) on behalf of the MRC-NIHR partnership (09/800/17) and will be published in full in Health Technology Assessment; Vol. 19, No. 38. FAU - Creswell, Cathy AU - Creswell C AD - School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK. FAU - Cruddace, Susan AU - Cruddace S AD - School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK. FAU - Gerry, Stephen AU - Gerry S AD - Centre for Statistics in Medicine, University of Oxford, Oxford, UK. FAU - Gitau, Rachel AU - Gitau R AD - School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK. FAU - McIntosh, Emma AU - McIntosh E AD - Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. FAU - Mollison, Jill AU - Mollison J AD - Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK. FAU - Murray, Lynne AU - Murray L AD - School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK. FAU - Shafran, Rosamund AU - Shafran R AD - Institute of Child Health, University College London, London, UK. FAU - Stein, Alan AU - Stein A AD - Department of Psychiatry, University of Oxford, Oxford, UK. FAU - Violato, Mara AU - Violato M AD - Health Economics Research Centre, University of Oxford, Oxford, UK. FAU - Voysey, Merryn AU - Voysey M AD - Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK. FAU - Willetts, Lucy AU - Willetts L AD - Berkshire Healthcare NHS Foundation Trust, Reading, UK. FAU - Williams, Nicola AU - Williams N AD - Centre for Statistics in Medicine, University of Oxford, Oxford, UK. FAU - Yu, Ly-Mee AU - Yu LM AD - Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK. FAU - Cooper, Peter J AU - Cooper PJ AD - School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK. LA - eng SI - ISRCTN/ISRCTN19762288 GR - G0601020/MRC_/Medical Research Council/United Kingdom GR - G0601874/MRC_/Medical Research Council/United Kingdom GR - RP_2014-04-018/DH_/Department of Health/United Kingdom PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - England TA - Health Technol Assess JT - Health technology assessment (Winchester, England) JID - 9706284 SB - IM MH - Anxiety Disorders/economics/*therapy MH - Child MH - Cognitive Behavioral Therapy/*economics/*methods MH - Cost-Benefit Analysis MH - Female MH - Humans MH - Male MH - Mother-Child Relations MH - Mothers/*psychology MH - Parenting/*psychology MH - Quality of Life MH - Quality-Adjusted Life Years MH - Socioeconomic Factors PMC - PMC4781330 EDAT- 2015/05/26 06:00 MHDA- 2016/02/19 06:00 PMCR- 2016/03/07 CRDT- 2015/05/26 06:00 PHST- 2015/05/26 06:00 [entrez] PHST- 2015/05/26 06:00 [pubmed] PHST- 2016/02/19 06:00 [medline] PHST- 2016/03/07 00:00 [pmc-release] AID - 10.3310/hta19380 [doi] PST - ppublish SO - Health Technol Assess. 2015 May;19(38):1-184, vii-viii. doi: 10.3310/hta19380.