Treatment and Prevention of Depression and Anxiety in Youth: Test of Cross-Over Effects

Abstract

Anxiety and depression are highly comorbid and share several common etiological processes. Therefore, it may be more efficient to develop interventions that treat or prevent these problems together rather than as separate entities. The present meta-analytic review examined whether interventions for children and adolescents that explicitly targeted either anxiety or depression showed treatment specificity or also impacted the other outcome (i.e., cross-over effects). We addressed this question both within the same type of study (i.e., treatment, prevention) and across study types. Only randomized controlled trials (RCTs) that assessed both constructs with dimensional measures were included in this review. For treatment studies, RCTs targeting anxiety (n=18) showed significant effects on both anxious and depressive symptoms, although more strongly on anxiety than depression; similarly, RCTs treating depression (n=9) yielded significant effects on both depressive and anxious symptoms, but stronger effects on depression than anxiety. Thus, there were cross-over effects in treatments purportedly targeting either anxiety or depression, and also treatment specificity, such that larger effects were seen for the target problem at which the treatment was aimed. Anxiety prevention studies (n=14) significantly affected anxious, but not depressive symptoms, indicating no cross-over effect of anxiety prevention trials on depression. For depression prevention studies (n=15), the effects were not significant for either depressive or anxiety symptoms, although the effect was significantly larger for depressive than for anxious symptoms. Post-hoc analyses revealed that the effect on depressive symptoms was significant in depression preventions trials of targeted but not universal samples. Implications for transdiagnostic interventions are discussed.

Randomized Clinical Trial of an Internet-Based Adolescent Depression Prevention Intervention in Primary Care: Internalizing Symptom Outcomes

“…Evidence of cross-over effects from CATCH-IT suggests that this prevention intervention, which was developed to address risk for depression only, may in fact target shared underlying mechanisms for both depression and anxiety. These results are counter to Garber et al [ 41 ], who, in a meta-analysis exploring cross-over effects for depression and anxiety treatment and prevention interventions, reported no evidence of cross-over effects for depression prevention programs. It is possible that the recruitment process, intervention engagement, and motivational interviews that accompany the CATCH-IT intervention, all of which emphasize building resilience, managing stressors, and working toward goals in addition to preventing low mood and depression, may help teens to generalize depression prevention skills to other distressing symptoms such as anxiety.…”

“…In fact, clinical research confirms that many treatments developed for depression also result in decreased symptoms of anxiety. One meta-analysis [ 41 ] reviewing randomized clinical treatment or prevention trials found that crossover effects were present in both depression treatments and anxiety treatments, although the effects were stronger for the targeted symptoms. That is, depression treatments had a greater effect on depressive symptoms than anxiety symptoms, and anxiety treatments had a greater effect on anxiety symptoms than depressive symptoms.…”

Clinical risk factors among youth at high risk for suicide in South Africa and Guyana

“…Youth suicide attempt was significantly correlated with a lifetime anxiety disorder in eight out of 13 studies, in meta-analytic review (Schaffer et al, 2015). Comorbid depression and anxiety disorders (Garber et al, 2016) were most prevalent among youth with suicidal behavior in a sample of Hungarian outpatients (Csorba, Dinya, Plener, Nagy, & Páli, 2009). Out of multiple psychiatric disorders assessed by the MINI, psychotic disorders emerged as an independent predictor of lifetime suicidality, and youth with a suicide attempt history had 6.7 greater odds of psychotic disorder compared with youth who did not (Kinyanda et al, 2011).…”

A 12-month follow-up of a transdiagnostic indicated prevention of internalizing symptoms in school-aged children: the results from the EMOTION study

“…Transdiagnostic approaches are developed based on the common comorbidity of these disorders and the similarities between the disorders in terms of etiology, risk factors, and treatment strategies [15,17]. Crossover effects from prevention programs that focus exclusively on either anxiety or depression further support the idea of targeting both symptom categories with the same intervention [18]. There are few studies of such interventions for youth, but the results to date are generally promising [19][20][21][22].…”