Disorder and Symptom Stability between Anxiety and Depressive Episodes in Youth

Anxiety and depressive disorders are the most prevalent disorders amongst youth (Institute of Health Metrics and Evaluation, 2019), and a notable subgroup relapses after treatment (Levy et al., 2021; Ginsburg et al., 2018; Kennard et al., 2006). Therefore, it is important to examine what contributes to this impairment in functioning and relapse rates. One barrier to fostering insight into the course of symptomatology is the assumption that anxiety and depressive disorders are mental health conditions in which an individual suffers from the same disorders (i.e., disorder stability) and symptoms (i.e., symptom stability) across episodes. To test this assumption of stability, aim of this study is to examine (1) disorder and (2) symptom stability between the relapse episode and either (a) the last episode prior to remission or (b) all lifetime episodes prior to remission of youth with anxiety and depressive disorders, controlling for severity change (i.e. change in number of disorders or symptoms). This will be done exploratively, through creation of stability proportions and Sankey diagrams. Furthermore, if disorder or symptom instability limits relapse prevention efficacy, it is important to consider what predicts instability, to be able to inform the development of relapse prevention interventions. Therefore, it is also examined whether (1a and 1b) disorder and (2a and 2b) symptom stability are predicted by a higher proportion of symptoms present during the remission phase (before the relapse episode) that were not part of (i) the prior episode or (ii) all prior episodes, compared to those that were. References Ginsburg, G. S., Becker-Haimes, E. M., Keeton, C., Kendall, P. C., Iyengar, S., Sakolsky, D., Albano, A. M., Peris, T., Compton, S. N., & Piacentini, J. (2018). Results from the child/adolescent anxiety multimodal extended long-term study (CAMELS): primary anxiety outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 57(7), 471–480. https://doi.org/10.1016/j.jaac.2018.03.017 Institute of Health Metrics and Evaluation. (2019). Global health data exchange (GHDx): GDB results. Institute of Health Metrics and Evaluation Seattle, WA, USA. Kennard, B. D., Emslie, G. J., Mayes, T. L., & Hughes, J. L. (2006). Relapse and Recurrence in Pediatric Depression. Child and adolescent psychiatric clinics of North America, 15(4), 1057–1079. https://doi.org/10.1016/j.chc.2006.05.003 Levy, H. C., Stevens, K. T., & Tolin, D. F. (2021). Research Review: A meta‐analysis of relapse rates in cognitive behavioral therapy for anxiety and related disorders in youth. Journal of Child Psychology and Psychiatry. https://doi.org/10.1111/jcpp.13486