Abstract
Zusammenfassung. Kinder und Jugendliche mit posttraumatischen Belastungsstörungen weisen häufig auch Angstsymptome und depressive Symptome auf. Diese Studie untersucht bei 159 Teilnehmern einer multizentrischen klinischen Studie (Alter 7 – 17 Jahre) die Vergesellschaftung posttraumatischer Stresssymptome (PTSS) mit Angst und Depression sowie das Ansprechen dieser Symptome auf traumafokussierte kognitive Verhaltenstherapie (TF-KVT). Bei Studienbeginn zeigten 121 (76 %) Patienten klinisch relevante Angstsymptome und 91 (57 %) klinisch relevante Depressionssymptome. PTSS waren signifikant mit Angst (r = .42, p < .001) sowie mit Depression (r = .49, p < .001) korreliert. Mit TF-KVT behandelte Patienten zeigten nicht nur eine deutliche Remission ihrer Stresssymptomatik, sondern auch ihrer Angst- und Depressionssymptome. Die Ergebnisse bestätigen die hohe Prävalenz klinisch relevanter Angst- und Depressionssymptome bei traumatisierten Kindern und Jugendlichen und verweisen auf transdiagnostische Effekte der TF-KVT.
Abstract. Anxiety and depression are frequent comorbid symptoms in children and adolescents with posttraumatic stress disorder (PTSD). Therefore, is it important to identify treatments that are effective not only with regard to the core symptoms of PTSD, but also regarding anxiety and depression. Methods: This study investigates in a sample of 159 participants (age 7 – 17 years, 72 % female) of a randomized controlled trial: (a) the frequency of clinically relevant symptoms of anxiety and depression, (b) the correlation of symptoms of anxiety and depression with posttraumatic stress symptoms (PTSS), and (c) the remission of comorbid symptoms of anxiety and depression after 12 sessions of trauma-focused cognitive behavioral therapy (TF-CBT) compared with a waitlist group (WL). All participants had been exposed to at least one traumatic event and had developed clinically relevant PTSS. PTSS were assessed with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA), whereas symptoms of anxiety were assessed via the Screen for Child Anxiety-Related Disorders (SCARED) and symptoms of depression were measured with the Child Depression Inventory (CDI). Clinical assessments were performed repeatedly at baseline and after treatment or 4 months of waiting time. Results: At baseline, 121 (76 %) of the patients showed clinically relevant symptoms of anxiety and 91 (57 %) had clinically relevant symptoms of depression. The triplet of PTSS, anxiety, and depression occurred in 78 (49 %) children and adolescents. PTSS were significantly correlated with caregiver-reported anxiety (r = .42, p < .001) and self-reported depression (r = .49, p < .001). Using repeated measures ANOVA, we found that patients treated with TF-CBT showed not only significantly greater remission of their PTSS compared with patients on the WL (F(1, 157) = 12.31, p = .001), but also of their caregiver-reported symptoms of anxiety, F(1, 147) = 6.29, p = .013, but not of their self-reported symptoms of anxiety, F(1, 155) = 2.37, p = .126. TF-CBT was also superior to WL regarding a remission of self-reported symptoms of depression, F(1, 155) = 8.11, p = .005. Beyond a large effect on PTSS (d = 1.51), TF-CBT generated moderate effects regarding symptoms of anxiety (self-report: d = 0.51; caregiver report: d = 0.51) and depression (d = 0.62). Conclusions and Relevance: Our results confirm the high prevalence of anxiety and depression in traumatized children and adolescents. Moreover, they demonstrate transdiagnostic effects of TF-CBT. Therefore, TF-CBT seems to be an appropriate treatment for traumatized children and adolescents with comorbid anxiety and depression.
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