SADS in Children - KQ4 and KQ5

Project Summary Title and Description

SADS in Children - KQ4 and KQ5
Screening for Anxiety Depression and Suicide Risk in Children and Adolescents - Key Questions 4 or 5 - Benefits and Harms of Treatment This project includes all studies that address KQ4 and/or KQ5.
Authors of Report
Meera Viswanathan, PhD Ina Wallace, PhD Jennifer Cook Middleton, PhD Sara M. Kennedy, MPH Joni McKeeman, PhD Kesha Hudson, PhD Caroline Rains, MPH Emily B. Vander Schaaf, MD, MPH Leila Kahwati, MD, MPH
Methodology description
Systematic Review
doi: 10.1001/jama.2022.16303
Background: Mental health conditions in children and adolescents may present as physical symptoms and may occur concurrently, presenting primary care physicians with opportunities to screen for one or more conditions. Purpose: To review the evidence on screening (benefits and harms of screening, accuracy of screening, benefits and harms of treatment) for suicide risk, anxiety, and depression in children and adolescents in settings relevant to primary care in the United States for the U.S. Preventive Services Task Force. Data Sources: PubMed, the Cochrane Library, PsycINFO, CINAHL and trial registries through July 19, 2021; bibliographies from retrieved articles, outside experts, and surveillance of the literature through June 1, 2022. Study Selection: Two investigators independently selected English-language studies using a priori defined criteria. We included trials that evaluated the benefits or harms of screening for suicide risk, anxiety, or depression compared with no screening or usual care. We included studies of screening with instruments feasible in primary care settings. For treatment benefits and harms, we included drugs approved for pediatric use by the Food and Drug Administration. For suicide and depression treatment studies, we included any eligible psychotherapy or collaborative care interventions. For anxiety, we restricted nonpharmacological interventions to cognitive behavioral therapy (CBT). Eligible outcomes included test accuracy, symptoms, response, remission, loss of diagnosis, all-cause mortality, functioning, suicide-related symptoms or events, withdrawal due to adverse events, serious adverse events, and harms from screening. We also included systematic reviews reporting on harms of treatment. We excluded studies with poor methodological quality. Data Extraction: One investigator extracted data and a second checked accuracy. Two reviewers independently rated methodological quality for all included studies. When at least three similar studies were available, we conducted meta-analyses. Link to full report:
Funding Source
AHRQ Contract No. HHSA-290-2015-00011-I, Task Order No. 15

Key Questions

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57. Key Question 4. Does treatment (psychotherapy, pharmacotherapy, or collaborative care) of depression, anxiety, or suicide risk result in improved health outcomes in children and adolescents?
58. Key Question 5. What are the harms of treatment (psychotherapy, pharmacotherapy, or collaborative care) in children and adolescents who are treated for depression, anxiety, or suicide risk?
59. Key Question 5. What are the harms of treatment (psychotherapy, pharmacotherapy, or collaborative care) in children and adolescents who are treated for depression, anxiety, or suicide risk?

Associated Extraction Forms


Associated Studies (each link opens a new tab)

Title Authors Year
Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Randomized Clinical Trial V. R. Weersing, D. A. Brent, M. S. Rozenman, A. Gonzalez, M. Jeffreys, J. F. Dickerson, F. L. Lynch, G. Porta, S. Iyengar 2017
A Randomized Controlled Trial of Parent-Child Psychotherapy Targeting Emotion Development for Early Childhood Depression J. L. Luby, D. M. Barch, D. Whalen, R. Tillman, K. E. Freedland 2018
Teen options for change: an intervention for young emergency patients who screen positive for suicide risk C. A. King, P. Y. Gipson, A. G. Horwitz, K. J. Opperman 2015
Chat- and internet-based cognitive-behavioural therapy in treatment of adolescent depression: randomised controlled trial N. Topooco, M. Berg, S. Johansson, L. Liljethrn, E. Radvogin, G. Vlaescu, L. B. Nordgren, M. Zetterqvist, G. Andersson 2018
Pilot Randomized Controlled Trial of Omega-3 and Individual-Family Psychoeducational Psychotherapy for Children and Adolescents With Depression M. A. Fristad, A. T. Vesco, A. S. Young, K. Z. Healy, E. S. Nader, W. Gardner, A. M. Seidenfeld, H. L. Wolfson, L. E. Arnold 2019
Evaluating the Efficacy of Internet-Delivered Cognitive Behavioral Therapy Blended With Synchronous Chat Sessions to Treat Adolescent Depression: Randomized Controlled Trial N. Topooco, S. Bylhn, E. Dahlstrm Nyster, J. Holmlund, J. Lindegaard, S. Johansson, L. berg, L. Bergman Nordgren, M. Zetterqvist, G. Andersson 2019
A randomized controlled trial of a bidirectional cultural adaptation of cognitive behavior therapy for children and adolescents with anxiety disorders S. I. Ishikawa, K. Kikuta, M. Sakai, T. Mitamura, N. Motomura, J. L. Hudson 2019
Cognitive Behavioral Therapy in Primary Care for Youth Declining Antidepressants: A Randomized Trial G. Clarke, L. L. DeBar, J. A. Pearson, J. F. Dickerson, F. L. Lynch, C. M. Gullion, M. C. Leo 2016
An initial waitlist-controlled trial of the unified protocol for the treatment of emotional disorders in adolescents J. Ehrenreich-May, D. Rosenfield, A. H. Queen, S. M. Kennedy, C. S. Remmes, D. H. Barlow 2017
Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety J. T. Walkup, A. M. Albano, J. Piacentini, B. Birmaher, S. N. Compton, J. T. Sherrill, G. S. Ginsburg, M. A. Rynn, J. McCracken, B. Waslick, S. Iyengar, J. S. March, P. C. Kendall 2008
A randomized, placebo-controlled study of duloxetine for the treatment of children and adolescents with generalized anxiety disorder J. R. Strawn, A. Prakash, Q. Zhang, B. A. Pangallo, C. E. Stroud, N. Cai, R. L. Findling 2015
Cognitive-Behavioral and Psychodynamic Therapy in Adolescents with Social Anxiety Disorder: A Multicenter Randomized Controlled Trial S. Salzer, A. Stefini, K. T. Kronmller, E. Leibing, F. Leichsenring, P. Henningsen, H. Peseschkian, G. Reich, R. Rosner, U. Ruhl, Y. Schopf, C. Steinert, E. Vonderlin, R. Steil 2018
A randomized controlled trial examining the efficacy of an internet-based cognitive behavioral therapy program for adolescents with anxiety disorders S. Stjerneklar, E. Hougaard, L. F. McLellan, M. Thastum 2019
Intensive group behavioral treatment (IGBT) for children with selective mutism: A preliminary randomized clinical trial D. Cornacchio, J. M. Furr, A. L. Sanchez, N. Hong, L. K. Feinberg, R. Tenenbaum, C. Del Busto, L. J. Bry, B. Poznanski, E. Miguel, T. H. Ollendick, S. M. S. Kurtz, J. S. Comer 2019
Working with parents to treat anxiety-disordered children: A proof of concept RCT evaluating Fear-less Triple P V. E. Cobham, A. Filus, M. R. Sanders 2017
School-Based Treatment for Anxiety Research Study (STARS): a Randomized Controlled Effectiveness Trial G. S. Ginsburg, J. E. Pella, P. J. Pikulski, J. Y. Tein, K. L. Drake 2020
Experience Versus Report: Where Are Changes Seen After Exposure-Based Cognitive-Behavioral Therapy? A Randomized Controlled Group Treatment of Childhood Social Anxiety Disorder J. Asbrand, N. Heinrichs, S. Schmidtendorf, K. Nitschke, B. Tuschen-Caffier 2020
Effectiveness of systemic family therapy versus treatment as usual for young people after self-harm: a pragmatic, phase 3, multicentre, randomised controlled trial D. J. Cottrell, A. Wright-Hughes, M. Collinson, P. Boston, I. Eisler, S. Fortune, E. H. Graham, J. Green, A. O. House, M. Kerfoot, D. W. Owens, E. C. Saloniki, M. Simic, F. Lambert, J. Rothwell, S. Tubeuf, A. J. Farrin 2018
Cognitive-Behavioral Family Treatment for Suicide Attempt Prevention: A Randomized Controlled Trial J. R. Asarnow, J. L. Hughes, K. N. Babeva, C. A. Sugar 2017
Efficacy of Mentalization-based group therapy for adolescents: the results of a pilot randomised controlled trial H. Griffiths, F. Duffy, L. Duffy, S. Brown, H. Hockaday, E. Eliasson, J. Graham, J. Smith, A. Thomson, M. Schwannauer 2019
Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial L. Mehlum, A. J. Trmoen, M. Ramberg, E. Haga, L. M. Diep, S. Laberg, B. S. Larsson, B. H. Stanley, A. L. Miller, A. M. Sund, B. Grholt 2014
Mentalization-based treatment for self-harm in adolescents: a randomized controlled trial T. I. Rossouw, P. Fonagy 2012
Randomised controlled trial of therapeutic assessment versus usual assessment in adolescents with self-harm: 2-year follow-up D. Ougrin, I. Boege, D. Stahl, R. Banarsee, E. Taylor 2013
Family intervention for adolescents with suicidal behavior: a randomized controlled trial and mediation analysis J. Pineda, M. R. Dadds 2013
Promoting CARE: including parents in youth suicide prevention C. Hooven, E. Walsh, K. C. Pike, J. R. Herting 2012
Fluvoxamine for the treatment of anxiety disorders in children and adolescents Pine, D. S., Walkup, J. T., Labellarte, M. J., Riddle, M. A., Greenhill, L., Klein, R., Davies, M., Sweeney, M., Abikoff, H., Hack, S. 2001
Treatment of child anxiety disorders via guided parent-delivered cognitive-behavioural therapy: randomised controlled trial Thirlwall, K., Cooper, P. J., Karalus, J., Voysey, M., Willetts, L., Creswell, C. 2013
GAD-Specific Cognitive Behavioral Treatment for Children and Adolescents: a Pilot Randomized Controlled Trial Perrin, S., Bevan, D., Payne, S., Bolton, D. 2019
A randomized controlled trial of internet-delivered cognitive behaviour therapy for adolescent anxiety disorders in a routine clinical care setting with and without parent sessions Waite, P., Marshall, T., Creswell, C. 2019
Pilot Randomized Controlled Trial of LEAP: a Selective Preventive Intervention to Reduce Adolescents' Perceived Burdensomeness Hill, R. M., Pettit, J. W. 2019
Effectiveness of group cognitive-behavioral treatment for childhood anxiety in community clinics Lau, Wai-yee, Chan, Charlotte Kwok-ying, Li, Johnson Ching-hong, Au, Terry Kit-fong 2010
Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children Lyneham, Heidi J., Rapee, Ronald M. 2006
Parent-led exposure therapy: A pilot study of a brief behavioral treatment for anxiety in young children Rudy, Brittany M., Zavrou, Sophia, Johnco, Carly, Storch, Eric A., Lewin, Adam B. 2017
Cognitivebehavioral therapy for youth anxiety: An effectiveness evaluation in community practice Villab, Marianne A., Narayanan, Martina, Compton, Scott N., Kendall, Philip C., Neumer, Simon-Peter 2018
Efficacy of a Danish version of the Cool Kids program: A randomized wait-list controlled trial Arendt, K., Thastum, M., Hougaard, E. 2016
Behavioral treatment of social phobia in youth: Does parent education training improve the outcome? st, Lars-Gran, Cederlund, Rio, Reuterskild, Lena 2015
Escitalopram in the treatment of adolescent depression: a randomized placebo-controlled multisite trial Emslie, G. J., Ventura, D., Korotzer, A., Tourkodimitris, S. 2009
A double-blind, randomized, placebo-controlled trial of escitalopram in the treatment of pediatric depression Wagner, K. D., Jonas, J., Findling, R. L., Ventura, D., Saikali, K. 2006
A randomized effectiveness trial of brief cognitive-behavioral therapy for depressed adolescents receiving antidepressant medication Clarke, G., Debar, L., Lynch, F., Powell, J., Gale, J., O'Connor, E., Ludman, E., Bush, T., Lin, E. H., Von Korff, M., Hertert, S. 2005
Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial March, J., Silva, S., Petrycki, S., Curry, J., Wells, K., Fairbank, J., Burns, B., Domino, M., McNulty, S., Vitiello, B., Severe, J. 2004
Cognitive-behavioral treatment of adolescent depression: efficacy of acute group treatment and booster sessions Clarke, G. N., Rohde, P., Lewinsohn, P. M., Hops, H., Seeley, J. R. 1999
Collaborative care for adolescents with depression in primary care: a randomized clinical trial Richardson, L. P., Ludman, E., McCauley, E., Lindenbaum, J., Larison, C., Zhou, C., Clarke, G., Brent, D., Katon, W. 2014
Group therapy for adolescents with repeated self harm: randomised controlled trial with economic evaluation Green, J. M., Wood, A. J., Kerfoot, M. J., Trainor, G., Roberts, C., Rothwell, J., Woodham, A., Ayodeji, E., Barrett, B., Byford, S., Harrington, R. 2011
Group therapy for repeated deliberate self-harm in adolescents: failure of replication of a randomized trial Hazell, P. L., Martin, G., McGill, K., Kay, T., Wood, A., Trainor, G., Harrington, R. 2009
Randomized trial of group therapy for repeated deliberate self-harm in adolescents Wood, A., Trainor, G., Rothwell, J., Moore, A., Harrington, R. 2001
Attachment-based family therapy for adolescents with suicidal ideation: a randomized controlled trial Diamond, G. S., Wintersteen, M. B., Brown, G. K., Diamond, G. M., Gallop, R., Shelef, K., Levy, S. 2010
Randomized study of school-based intensive interpersonal psychotherapy for depressed adolescents with suicidal risk and parasuicide behaviors Tang, T. C., Jou, S. H., Ko, C. H., Huang, S. Y., Yen, C. F. 2009
The Youth-Nominated Support Team-Version II for suicidal adolescents: A randomized controlled intervention trial King, C. A., Klaus, N., Kramer, A., Venkataraman, S., Quinlan, P., Gillespie, B. 2009
Treatment of elective mutism with fluoxetine: a double-blind, placebo-controlled study Black, B., Uhde, T. W. 1994
Fluoxetine for the treatment of childhood anxiety disorders Birmaher, B., Axelson, D. A., Monk, K., Kalas, C., Clark, D. B., Ehmann, M., Bridge, J., Heo, J., Brent, D. A. 2003
Placebo-controlled trial of sertraline in the treatment of children with generalized anxiety disorder Rynn, M. A., Siqueland, L., Rickels, K. 2001
Family treatment of childhood anxiety: a controlled trial Barrett, P. M., Dadds, M. R., Rapee, R. M. 1996
The efficacy of a group-based, disorder-specific treatment program for childhood GAD--a randomized controlled trial Holmes, M. C., Donovan, C. L., Farrell, L. J., March, S. 2014
Cognitive behavioral therapy for 4- to 7-year-old children with anxiety disorders: a randomized clinical trial Hirshfeld-Becker, D. R., Masek, B., Henin, A., Blakely, L. R., Pollock-Wurman, R. A., McQuade, J., DePetrillo, L., Briesch, J., Ollendick, T. H., Rosenbaum, J. F., Biederman, J. 2010
Evaluating the FRIENDS program: a cognitive-behavioral group treatment for anxious children and their parents Shortt, A. L., Barrett, P. M., Fox, T. L. 2001
Online CBT for preschool anxiety disorders: a randomised control trial Donovan, C. L., March, S. 2014
Effectiveness of a program for early detection/intervention in children/adolescents with generalized social phobia Snchez-Garca, Raquel, Olivares Rodrguez, Jos 2009
Escitalopram in Adolescents With Generalized Anxiety Disorder: A Double-Blind, Randomized, Placebo-Controlled Study Strawn, J. R., Mills, J. A., Schroeder, H., Mossman, S. A., Varney, S. T., Ramsey, L. B., Poweleit, E. A., Desta, Z., Cecil, K., DelBello, M. P. 2020
A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents Mufson, L., Dorta, K. P., Wickramaratne, P., Nomura, Y., Olfson, M., Weissman, M. M. 2004
Affect-Focused Psychodynamic Internet-Based Therapy for Adolescent Depression: randomized Controlled Trial Lindqvist, K., Mechler, J., Carlbring, P., Lilliengren, P., Falkenstrm, F., Andersson, G., Johansson, R., Edbrooke-Childs, J., Dahl, H. J., Lindert Bergsten, K. 2020

Downloadable Data Content

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