Predictors of treatment response in anxious-depressed adolescents with school refusal.
OBJECTIVE
To identify predictors of treatment response to 8 weeks of cognitive-behavioral therapy (CBT) among anxious-depressed adolescents with school refusal, half of whom received imipramine plus CBT and half of whom received placebo plus CBT.


METHODS
A hierarchical multiple regression analysis was used to evaluate the following variables as potential predictors of treatment response as measured by school attendance at the end of treatment: baseline severity (school attendance at baseline), drug group (imipramine versus placebo), presence of separation anxiety disorder (SAD), and presence of avoidant disorder (AD).


RESULTS
Baseline attendance, CBT plus imipramine, SAD, and AD were significant predictors of treatment response and accounted for 51% of the variance in outcome. Specifically, a higher rate of attendance at baseline and receiving imipramine predicted a better response to treatment whereas the presence of SAD and AD predicted a poorer response to treatment. The relationship between sociodemographic variables and treatment outcome was also evaluated. Age and socioeconomic status were unrelated to school attendance after treatment. Males had significantly higher rates of attendance after treatment than females.


CONCLUSIONS
Adolescents with school refusal are a heterogeneous population and require individualized treatment planning. Variables such as diagnosis and severity at the start of treatment should be taken into consideration when planning treatment.
Layne
Ann E
AE
Division of Child and Adolescent Psychiatry, University of Minnesota Medical School, Minneapolis, USA.
Bernstein
Gail A
GA
Egan
Elizabeth A
EA
Kushner
Matt G
MG
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D007099:Imipramine / Q000627:therapeutic use; D008297:Male; D011446:Prospective Studies; D012044:Regression Analysis; D016037:Single-Blind Method; D013332:Student Dropouts
D000929:Antidepressive Agents, Tricyclic; D007099:Imipramine