Short term effects of inpatient cognitive behavioral treatment of adolescents with anxious-depressed school absenteeism: an observational study.
This observational study examined the changes during inpatient cognitive-behavioral treatment (CBT) of adolescents with chronic anxious-depressive school absenteeism with or without comorbid disruptive symptoms. 147 adolescents (aged 12-18 years) with a specific phobia or other anxiety disorder or a depressive episode or a mixed disorder of conduct and emotions and who had completely ceased to attend school or showed irregular school attendance underwent an inpatient cognitive-behavioral treatment. A further 16 patients aborted the treatment during the first day and were not included in the analyses. The treatment was manual guided and also included parents. Assessments were made pre-inpatient treatment, immediately post-inpatient treatment and at 2-month follow-up. School attendance was the primary outcome variable and secondary outcomes were composite scores of a range of adolescent- and parent-rated mental health problems. Overall, results show a considerable decline of school absenteeism and mental health problems during treatment and subsequent follow-up. Continuous school attendance was achieved by 87.1% of the sample at the end of inpatient treatment and by 82.3% at 2-month follow-up. Comorbid symptoms of anxiety, depression, disruptive and insufficient learning behavior were significantly reduced from pre to follow-up, with effect sizes for the composite scores ranging from 0.44 to 1.15 (p < 0.001). This large observational study in adolescents with school absenteeism and a mixture of emotional and disruptive symptoms is the first to show the benefits of inpatient therapy that included cognitive-behavioral therapy and access to a special school with expertise on teaching children and adolescents with psychiatric disorders. The results must be interpreted conservatively because of the lack of a control condition.
Walter
Daniel
D
Department for Child and Adolescent Psychiatry and Psychotherapy, University of Cologne, Robert-Koch-Str. 10, 50931 Cologne, Germany. daniel.walter@uk-koeln.de
Hautmann
Christopher
C
Rizk
Saada
S
Petermann
Maike
M
Minkus
Johannes
J
Sinzig
Judith
J
Lehmkuhl
Gerd
G
Doepfner
Manfred
M
D000041:Absenteeism; D000293:Adolescent; D001008:Anxiety Disorders / Q000150:complications / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy; D003866:Depressive Disorder / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D012574:Schools; D013334:Students