Favourable short-term course and outcome of pediatric anxiety spectrum disorders: a prospective study from India

Abstract

Background Although anxiety disorders are the most prevalent psychiatric disorders among children and adolescents, there is a paucity of research on the course and outcome of anxiety spectrum disorders in low and middle-income countries. Methods 60 children and adolescents aged 6–16 years with anxiety spectrum disorders attending the child and adolescent psychiatry department in a tertiary care center from India were included after taking written informed consent and assent in this prospective study conducted between April 2012 to May 2014. Assessments were done at baseline, 12 weeks and 24 weeks using pediatric anxiety rating scale, clinical global impression-severity, clinical global assessment scale and pediatric quality of life scale; MINI-KID (version 6.0) was used to examine remission status. Results Mean age of children was 12.68 years and mean duration of illness was 34.52 months. Follow-up rate at 24 weeks was 80% with a remission rate of 64.6%. Socio-demographic factors did not affect the baseline severity or course and outcome measures. Children with greater baseline severity and social phobia had a less favorable outcome at 24 weeks. Improvements made in the initial 12 weeks were maintained at 24 weeks follow up. These findings are in line with earlier studies from high-income countries. Limitations Small sample size, attrition, rater bias. Conclusion The study has shown a favorable outcome in children and adolescents with anxiety spectrum disorders receiving treatment-as-usual in a tertiary care setting. Adolescents who present with greater severity, comorbid with other anxiety disorders and depression at baseline require intensive intervention, and long-term follow up. There is a need for interventional research with specific focus on universal preventive programs for anxiety spectrum disorders that are feasible for delivery in low and middle-income countries.

Sociodemographic Correlates of Anxiety Disorders in Children: A Cross-sectional Study in an Indian Outpatient Setting

“…In the current study, 29% of children with an anxiety disorder had school refusal and avoided school, reflecting significant impairment in academic functioning. These findings are similar to that of a latest study from National Institute of Mental Health and Neurosciences [21], which found that nearly one-third of the sample had school refusal. Although school refusal is not an anxiety disorder and may be motivated by many factors aside from anxiety, but when it occurs, anxiety is a common underlying element such as fear of the school work, separation anxiety, social fears, etc.…”

Cognitive Behavior Therapy for Children with Anxiety: Considerations for a Low Resource Setting like India

“…Another recent study [44] has shown a favorable outcome in children and adolescents with anxiety spectrum disorders receiving treatment-as-usual in a tertiary care setting. The authors indicate a need for interventional research with a specific focus on universal preventive programs for anxiety spectrum disorders that are feasible for delivery in low and middle-income countries.…”

School Refusal Behavior: A Narrative Review

“…For instance, in some studies, almost 30% children with anxiety disorders have been described to present with school refusal initially. 18, 19 Allen and colleagues have previously reported that mental health conditions impair the cognitive and emotional development of the child. 20 Often, this leads to difficulty coping with school and causes children to refuse to attend school.…”