Predicting outcomes following cognitive behaviour therapy in child anxiety disorders: the influence of genetic, demographic and clinical information

Authors

  • Jennifer L. Hudson,

    Corresponding author
    1. Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
    • Correspondence

      Jennifer L. Hudson, Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia; Email: jennie.hudson@mq.edu.au

      Kathryn J. Lester, King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, London, UK; Email: kathryn.lester@kcl.ac.uk

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    • Jennifer L Hudson and Kathryn J Lester contributed equally to this work.
  • Kathryn J. Lester,

    Corresponding author
    1. King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, London, UK
    • Correspondence

      Jennifer L. Hudson, Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia; Email: jennie.hudson@mq.edu.au

      Kathryn J. Lester, King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, London, UK; Email: kathryn.lester@kcl.ac.uk

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    • Jennifer L Hudson and Kathryn J Lester contributed equally to this work.
  • Cathryn M. Lewis,

    1. King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, London, UK
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  • Maria Tropeano,

    1. King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, London, UK
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  • Cathy Creswell,

    1. Winnicott Research Unit, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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  • David A. Collier,

    1. King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, London, UK
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  • Peter Cooper,

    1. Winnicott Research Unit, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
    2. Psychology Department, Stellenbosch University, Stellenbosch, South Africa
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  • Heidi J. Lyneham,

    1. Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
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  • Talia Morris,

    1. Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
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  • Ronald M. Rapee,

    1. Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
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  • Susanna Roberts,

    1. King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, London, UK
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  • Jennifer A. Donald,

    1. Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
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  • Thalia C. Eley

    1. King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, London, UK
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  • Conflicts of interest statement: Potential conflicts disclosed in Acknowledgements.
  • Correction Note: This article was first published online on the 18th of June 2013, under a subscription publication licence. The article has since been made OnlineOpen, and the copyright line and licence statement was therefore updated in October 2014.

Abstract

Background

Within a therapeutic gene by environment (G × E) framework, we recently demonstrated that variation in the Serotonin Transporter Promoter Polymorphism; 5HTTLPR and marker rs6330 in Nerve Growth Factor gene; NGF is associated with poorer outcomes following cognitive behaviour therapy (CBT) for child anxiety disorders. The aim of this study was to explore one potential means of extending the translational reach of G × E data in a way that may be clinically informative. We describe a ‘risk-index’ approach combining genetic, demographic and clinical data and test its ability to predict diagnostic outcome following CBT in anxious children.

Method

DNA and clinical data were collected from 384 children with a primary anxiety disorder undergoing CBT. We tested our risk model in five cross-validation training sets.

Results

In predicting treatment outcome, six variables had a minimum mean beta value of 0.5:5HTTLPR, NGF rs6330, gender, primary anxiety severity, comorbid mood disorder and comorbid externalising disorder. A risk index (range 0–8) constructed from these variables had moderate a predictive ability (AUC = .62–.69) in this study. Children scoring high on this index (5–8) were approximately three times as likely to retain their primary anxiety disorder at follow-up as compared with those children scoring 2 or less.

Conclusion

Significant genetic, demographic and clinical predictors of outcome following CBT for anxiety-disordered children were identified. Combining these predictors within a risk index could be used to identify which children are less likely to be diagnosis-free following CBT alone and require longer or enhanced treatment. The ‘risk-index’ approach represents one means of harnessing the translational potential of G × E data.

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