title: Parental psychopathology and treatment outcome for anxious youth: roles of family functioning and caregiver strain.
abstract: OBJECTIVE
  Research has examined the effects of parental psychopathology, family functioning, and caregiver strain on treatment response in anxious youths. Although these variables have shown individual links to youth treatment response, theoretical models for their combined effects remain unexplored. This study tested the hypothesis that improvements in family functioning and reductions in caregiver strain explained the effects of parental psychopathology on youth treatment outcome in an anxiety treatment trial.
  
  
  METHODS
  A multiple mediation technique was used to test the proposed model across independent evaluator (IE), parent, and youth informants in 488 youths, aged 7-17 years (50% female; mean age = 10.7) meeting Diagnostic and Statistical Manual of Mental Disorders criteria for social phobia, separation anxiety, and/or generalized anxiety disorder. Youths were randomized to receive 12 weeks of cognitive-behavioral treatment (Coping Cat), medication (sertraline), their combination, or a pill placebo. At pre- and posttreatment, parents completed self-report measures of global psychopathology symptoms, family functioning, and caregiver strain; parents, youths, and IEs rated youths' anxiety symptom severity.
  
  
  RESULTS
  Changes in family functioning and caregiver strain jointly explained relations between parental psychopathology and reductions in youth anxiety. Specifically, across IE and parent informants, families with higher pretreatment parental psychopathology showed more improvement in family functioning and caregiver strain, which in turn predicted greater youth anxiety reductions. Further, higher pretreatment parental psychopathology predicted greater caregiver strain reductions and, in turn, greater youth anxiety reductions, based on youths' reports of their own anxiety.
  
  
  CONCLUSIONS
  Findings suggest that improvements in family functioning and reductions in caregiver strain can influence treatment outcomes for anxious youths, especially among youths with more distressed parents.
authors.affiliation: Department of Psychology.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Schleider
authors.affiliation: Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine.
authors.forename: Golda S
authors.initials: GS
authors.lastname: Ginsburg
authors.affiliation: Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine.
authors.forename: Courtney P
authors.initials: CP
authors.lastname: Keeton
authors.affiliation: Department of Psychology.
authors.forename: John R
authors.initials: JR
authors.lastname: Weisz
authors.affiliation: Department of Psychiatry, University of Pittsburgh.
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.affiliation: Department of Psychology, Temple University.
authors.forename: Phillip C
authors.initials: PC
authors.lastname: Kendall
authors.affiliation: Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
authors.forename: John
authors.initials: J
authors.lastname: Piacentini
authors.affiliation: Division of Services and Intervention Research, National Institute of Mental Health.
authors.forename: Joel
authors.initials: J
authors.lastname: Sherrill
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College.
authors.forename: John T
authors.initials: JT
authors.lastname: Walkup
mesh_terms: D000293:Adolescent; D000818:Animals; D000928:Antidepressive Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data; D002648:Child; D016241:Child of Impaired Parents / Q000523:psychology* / Q000706:statistics & numerical data; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000523:psychology; D010290:Parents / Q000523:psychology*; D057566:Self Report; D020280:Sertraline / Q000627:therapeutic use*; D013315:Stress, Psychological / Q000523:psychology*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D020280:Sertraline