Comorbid conditions are the rule for children with mood disorders, and they pose complications when evaluating treatment studies. Comorbid anxiety disorders, in particular, have been found to predict an earlier age of onset and more hospitalizations in youth with bipolar disorder (Dickstein et al., 2005) and higher depression index scores in youth with depression (Rohde, Clarke, Lewinsohn, Seeley, & Kaufman, 2001). These studies suggest mood disorders with comorbid anxiety may represent a more severe form of illness than mood disorders alone. Few controlled trials have examined the comorbidity of anxiety disorders in children with mood disorders (Kendall, Kortlander, Chansky, & Brady, 1992), particularly pediatric bipolar disorder (Dickstein et al., 2005). Even fewer studies have examined the differential impact of treatment on children with mood and anxiety disorders. Family-based psychoeducational psychotherapy is one psychosocial intervention investigated for children with mood disorders. One goal of psychoeducational psychotherapy is to help parents become better advocates for their children, selecting more appropriate treatments to help manage mood disorders and comorbidities.
Multifamily Psychoeducational Psychotherapy (MF-PEP) groups are an eight-session, manual-driven treatment for children with mood disorders designed as an adjunct to current medications and psychotherapy. 165 children with mood disorders, age 8-11, participated. Approximately 70% of participants were diagnosed with bipolar spectrum disorders (BPD), 30% with depressive spectrum disorders. Most had both comorbid behavioral (97%) and anxiety (69%) disorders. Assessments were conducted four times: at baseline, 6, 12, and 18 months. Approximately half (n=78) were randomized into immediate treatment and half (n=87) into a one-year wait-list condition. All were encouraged to continue treatment-as-usual.
The first objective was to examine the prevalence of comorbid anxiety disorders among MF-PEP participants. There were a mean number of 1.4 anxiety disorders per child. There were no differences in the number or prevalence of anxiety disorders between patients with BPD versus patients with depressive disorders. The two most common comorbid anxiety disorders were specific phobia and GAD.
Analyses were conducted at both the diagnostic and symptom level. At baseline, participants with comorbid anxiety disorders (+ANX) had higher levels of depressive symptom severity, but showed no difference in manic symptom severity, global functioning, and suicidality on either parent or child report compared to participants without comorbid anxiety disorders (-ANX). Higher levels of anxiety symptomatology were associated with greater functional impairment and greater depressive symptom severity at baseline, but no difference in manic symptom severity.
MF-PEP did not lead to a significant reduction in anxiety symptoms post-treatment. +ANX showed similar improvement to –ANX as a result of MF-PEP on both parent and child-reported depressive and manic symptom severity ratings and overall functioning. Anxiety symptomatology did not have an effect on improvement in manic or depressive symptom severity as a result of MF-PEP. Children with higher anxiety symptomatology showed greater improvement in global functioning scores as a result of MF-PEP, perhaps due to their lower global functioning scores at baseline. Clinical implications and directions for future research are discussed.