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首页> 外文期刊>Journal of the American Academy of Child and Adolescent Psychiatry >Searching for moderators and mediators of pharmacological treatment effects in children and adolescents with anxiety disorders.
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Searching for moderators and mediators of pharmacological treatment effects in children and adolescents with anxiety disorders.

机译：寻找患有焦虑症的儿童和青少年的药理作用的调节剂和调节剂。

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OBJECTIVE: To examine whether age, gender, ethnicity, type of anxiety disorder, severity of illness, comorbidity, intellectual level, family income, or parental education may function as moderators and whether treatment adherence, medication dose, adverse events, or blinded rater's guess of treatment assignment may function as mediators of pharmacological treatment effect in children and adolescents with anxiety disorders. METHOD: The database of a recently reported double-blind placebo-controlled trial of fluvoxamine in 128 youths was analyzed. With a mixed-model random-effects regression analysis of the Pediatric Anxiety Rating Scale total score, moderators and mediators were searched by testing for a three-way interaction (strata by treatment by time). A two-way interaction (strata by time) identified predictors of treatment outcome. RESULTS: No significant moderators of efficacy were identified, except for lower baseline depression scores, based on parent's (but not child's) report, being associated with greater improvement (p < .001). Patients with social phobia (p < .05) and greater severity of illness (p < .001) were less likely to improve, independently of treatment assignment. Blinded rater's guess of treatment assignment acted as a possible mediator (p < .001), but improvement was attributed to fluvoxamine, regardless of actual treatment assignment. Treatment adherence tended to be associated (p = .05) with improvement. CONCLUSIONS: In this exploratory study, patient demographics, illness characteristics, family income, and parental education did not function as moderators of treatment effect. Social phobia and severity of illness predicted less favorable outcome. Attribution analyses indicated that study blindness remained intact. The presence of concomitant depressive symptoms deserves attention in future treatment studies of anxious children.
机译：目的：检查年龄，性别，种族，焦虑症的类型，疾病的严重程度，合并症，智力水平，家庭收入或父母教育是否可以作为调节者，以及治疗依从性，药物剂量，不良事件或盲目评估者的猜测的治疗分配可能充当焦虑症儿童和青少年药理治疗作用的介质。方法：分析了最近报道的氟伏沙明在128名青年中的双盲安慰剂对照试验的数据库。通过对小儿焦虑症评定量表总分的混合模型随机效应回归分析，通过测试三效交互作用（按治疗时间分层）来搜索主持人和调解人。双向交互作用（按时间分层）确定了治疗结果的预测因素。结果：根据父母（但不是孩子）的报告，除基线抑郁评分较低以外，没有发现明显的疗效调节剂，与改善程度更大相关（p <.001）。社交恐惧症（p <.05）和疾病严重程度（p <.001）的患者改善病情的可能性较小，与治疗分配无关。盲目评估者对治疗分配的猜测可能是介导的（p <.001），但无论实际治疗分配如何，氟伏沙明都可以改善病情。治疗依从性往往与改善相关（p = .05）。结论：在这项探索性研究中，患者的人口统计学特征，疾病特征，家庭收入和父母教育没有起到调节治疗效果的作用。社交恐惧症和疾病的严重程度预示了不良的结局。归因分析表明，研究失明仍保持不变。伴随抑郁症状的存在值得对焦虑儿童进行进一步的治疗研究。

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