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Cited by 162Child and Adolescent Psychosocial and Emotional DevelopmentAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMaternal Mental Health During Pregnancy and Postpartum

Preventing onset of anxiety disorders in offspring of anxious parents: a randomized controlled trial of a family-based intervention

Open access
Ginsburg, Golda S., Drake, Kelly L., Tein, Jenn-Yun, Teetsel, Rebekah, Riddle, Mark A.·2015·American Journal of Psychiatry
DOI 10.1176/appi.ajp.2015.14091178PMC PMC6013063
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Abstract

OBJECTIVE: The authors examined the efficacy of a family-based intervention to prevent the onset of anxiety disorders in offspring of anxious parents. METHOD: Participants were 136 families with a parent meeting DSM-IV criteria for an anxiety disorder and one child 6-13 years of age without an anxiety disorder. Families were randomly assigned to the family-based intervention (N=70) or to an information-monitoring control condition (N=66). All families were expected to complete assessments, administered by blind interviewers, at baseline, at the end of the intervention (or 8 weeks after randomization) and at 6- and 12-month follow-ups. Onset of any anxiety disorder and anxiety symptom severity (assessed using the Anxiety Disorders Interview Schedule for Children) at 12 months were the primary and secondary outcome measures, respectively. RESULTS: The incidence of child anxiety disorders was 31% in the control group and 5% in the intervention group (odds ratio=8.54, 95% CI=2.27, 32.06). At the 1-year follow-up, youths in the control group also had higher anxiety symptoms ratings than those in the intervention group. Effect sizes were medium to large (0.81 at 6 months and 0.57 at 12 months for anxiety symptoms), and the number needed to treat was 3.9 at 12 months. Significant moderators included baseline levels of child anxiety; significant mediators were parental distress and modeling of anxiety. Child maladaptive cognitions and parental anxiety did not mediate outcomes. CONCLUSIONS: A brief psychosocial prevention program holds promise for reducing the 1-year incidence of anxiety disorders among offspring of anxious parents.

Integrity signals

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Crossref · 10.1176/appi.ajp.2015.14091178

Cites

32 of 32 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 28 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Survival analysis showed that the rate of onset of anxiety disorders was 6.6 times higher in the control group than in the intervention group over the 1-year period, with a hazard ratio of 6.60 and 95% confidence interval of 2.00 to 21.82.

    “The results of the survival analysis indicated that the rate of onset of anxiety disorders for children in the control group was 6.6 times higher than that for children in intervention group during the 1-year period (hazard ratio=6.60, 95% CI=2.00, 21.82; p=0.002).”
    Quote in the paperSubstantial claim
  • Findingown data

    The number needed to treat was 3.9 at 12 months.

    “number needed to treat=3.9”
    • Also stated in: § Results · plain
      “the number needed to treat was 3.9 at 12 months.”
    Quote in the paperSubstantial claim
  • Findingown data

    The intervention benefit was stronger for children with higher baseline anxiety symptoms than for those with lower baseline anxiety symptoms.

    “the benefit of the intervention was stronger for children with higher baseline anxiety symptoms than for those with lower baseline anxiety symptoms”
    • Also stated in: § DISCUSSION · plain
      “among youths who received the intervention, those with high baseline anxiety symptom severity levels showed greater reductions in severity than those with low baseline levels”
    Quote in the paperSubstantial claim
  • Findingown data

    The total number of sessions attended was not related to child outcomes.

    “Total number of sessions attended was unrelated to child outcomes.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The odds ratio for onset of child anxiety disorder was 8.54, with a 95% confidence interval of 2.27 to 32.06.

    “(odds ratio=8.54, 95% CI=2.27, 32.06)”
    Quote in the paperSubstantial claim
  • May combine two claims. 24
  • Classified as probably not a substantial claim. 19
  • The quote only partly states this claim. 2

  • May combine two claims.

    Findingown data

    Both groups improved from baseline to the end of intervention, but the intervention group had a significantly greater reduction in anxiety symptoms than the control group, with a between-group difference of -3.02 (95% CI, -5.04 to -1.00).

    “although both groups improved from baseline to end of intervention, the scores were reduced significantly more in the intervention group (B=−5.23, SE=0.82, p<0.01) compared with the control group (B=−2.21, SE=0.63, p<0.01) (difference=−3.02, 95% CI=−5.04, −1.00]).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Mental health service use for child anxiety was reported by 21.5% of control families and 13.2% of intervention families, a difference that was not statistically significant.

    “21.5% of the control families, compared with 13.2% of the intervention families, reported receiving mental health services for their child’s anxiety over the course of the study (not a statistically significant difference).”
    • Also stated in: § DISCUSSION · plain
      “we observed a higher rate of mental health service utilization among participants in the control condition, although it was not statistically different from the rate in the intervention group.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Parents who dropped out were significantly younger on average than those who remained, with mean ages of 41.3 years versus 37.2 years.

    “parents who dropped out were significantly younger on average (mean age, 41.3 years compared with 37.2 years; p=0.002).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Mean parental age was higher in the information-monitoring group than in the intervention group.

    “Mean parental age was higher in the information-monitoring group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Intervention effects were moderated by baseline child anxiety symptoms but not by child age, child gender, parent gender, parent anxiety, parent comorbidity, or parent-child gender match.

    “The intervention effects were moderated by baseline child anxiety symptoms but not by any of the other moderators examined (child age and gender; parent gender, anxiety, comorbidity; parent-child gender match).”
    • Also stated in: § DISCUSSION · plain
      “the intervention had a similar effect for girls and boys as well as for younger compared with older youths, although the majority of youths fell into a narrow age range (7–12 years old).”
    • Also stated in: § DISCUSSION · plain
      “parental trait anxiety level was not found to moderate outcomes”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The intervention and control groups did not differ significantly at baseline on child demographic variables or on child or parent anxiety levels.

    “The two groups did not differ significantly on child demographic variables or on levels of child or parent anxiety.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    From the postintervention assessment to the 12-month follow-up, the intervention group had additional significant reductions in anxiety symptoms, while the control group did not.

    “From the postintervention assessment to the 12-month follow-up, additional significant reductions occurred for the intervention group (B=−0.43, SE=0.13, p<0.01) but not for the control group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Changes in child maladaptive cognitions did not mediate the intervention effects on outcomes, and the intervention did not affect these cognitions.

    “Changes in child maladaptive cognitions did not mediate the intervention effects on outcomes.”
    • Also stated in: § DISCUSSION · plain
      “child maladaptive cognitions, which have been found to be elevated in youths with anxiety disorders and to be a mediator of treatment response in clinically anxious youths (33), were not affected by the intervention, and reductions in these cognitions did not explain the interventions’ effects at the 1-year follow-up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The largest reduction in anxiety symptoms occurred immediately after the intervention, and reductions were sustained for youths who received the intervention.

    “while the largest reduction in anxiety symptoms was observed immediately after the intervention, reductions in anxiety symptoms were sustained for youths who received the intervention.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    About one in ten children and adolescents in the United States has an anxiety disorder, and this condition interferes with their social, family, and school functioning.

    “On average, 10% of children and adolescents in the United States meet criteria for an anxiety disorder, which impairs their social, familial, and academic functioning (1, 2).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1]

      Not checked in the free run.

    • cites [2]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Etiological models of anxiety disorders point to multiple family-based risk factors.

    “Etiological models of anxiety disorders implicate several family-based risk factors (3).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3]

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Attrition differed between groups: significantly more children in the intervention condition failed to complete the 1-year assessment within the allotted window, and the completion rate for study evaluations was higher in the control group.

    “There were also group differences in the attrition rate, with significantly more children in the intervention condition failing to complete the 1-year assessment within the allotted window (p=0.03; see the CONSORT diagram in the online data supplement).”
    • Also stated in: § Limitations · plain
      “The completion rate for study evaluations was higher in the control group than in the intervention group”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Differential attrition between the intervention and control groups does not bias the intervention effect estimates.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Assessments were administered by interviewers who were blind to intervention condition.

    “All families were expected to complete assessments, administered by blind interviewers, at baseline, at the end of the intervention (or 8 weeks after randomization) and at 6- and 12-month follow-ups.”
    • Also stated in: § Procedures · plain
      “administered by interviewers blind to intervention condition and reviewed by a senior child psychiatrist”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The moderation finding is consistent with data from other prevention trials for anxiety.

    “This is consistent with data from other prevention trials for anxiety (30)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30]

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The mediation finding clarifies potential mechanisms and suggests that targeting specific parenting behaviors and lowering parents' overall distress were critical in reducing child anxiety symptoms.

    “This finding clarifies potential mechanisms of the intervention’s impact and suggests that targeting specific parenting behaviors (such as reducing anxious modeling) and lowering parents’ overall distress levels (not anxiety specifically) were critical in reducing child anxiety symptoms.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Anxiety prevention programs so far have had only modest success, and most have been delivered in schools as universal prevention.

    “To date, anxiety prevention programs have been only modestly successful, and most have been conducted in schools (i.e., a universal prevention approach) (9, 10).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [9]

      Not checked in the free run.

    • cites [10]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Families in the intervention group attended an average of 6.63 of eight sessions and 1.2 of three booster sessions, for a total mean of 9.01 of 11 sessions.

    “the average number of sessions attended was 6.63 out of eight (range, 0–8) and 1.2 out of three booster sessions (range, 0–3); the total mean number of sessions attended was 9.01 out of 11 (SD=2.63, range, 0–11).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The Coping and Promoting Strength program, a brief family-based cognitive-behavioral intervention, reduced the incidence of anxiety disorders and the severity of anxiety symptoms over 1 year in offspring of anxious parents.

    “The study demonstrated that the Coping and Promoting Strength program, a brief family-based cognitive-behavioral intervention, reduced the incidence of anxiety disorders and the severity of anxiety symptoms over a 1-year period in offspring of anxious parents, a population at high risk for developing anxiety disorders.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Intention-to-treat analyses were conducted in Mplus version 7.11 using full-information maximum-likelihood estimation to handle missing data.

    “Intention-to-treat analyses were performed in Mplus, version 7.11 (25), using full-information maximum-likelihood estimation to handle missing data.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Missing outcome data are missing at random, so full-information maximum-likelihood estimation yields unbiased estimates of intervention effects.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Independent evaluators were supervised by a senior child psychiatrist who reviewed all diagnoses and severity ratings and stayed blind to intervention condition throughout the study.

    “The independent evaluators were supervised by a senior child psychiatrist (M.A.R.) who reviewed all diagnoses and clinical severity ratings and remained blind to intervention condition throughout the study.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Families were randomly assigned to the family-based intervention or to an information-monitoring control condition in a 1:1 ratio.

    “Families were randomly assigned to the family-based intervention (N=70) or to an information-monitoring control condition (N=66).”
    • Also stated in: § Procedures · plain
      “Eligible families were randomly assigned in a 1:1 ratio to an intervention condition (using random numbers derived from randomization.com).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    The study did not examine an exhaustive list of potential moderators and mediators, the sample size for specific moderation effects was small, and analyses were likely underpowered to detect these effects.

    “We did not examine an exhaustive list of potential moderators and mediators, the sample size for specific moderation effects was small, and analyses were likely to be underpowered to detect these effects.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    For analyses involving the variable with the outlier, results were consistent with and without the outlier, and the more conservative results without the outlier were presented.

    “For analyses involved with this variable, the results were consistent between the models with and without the outlier. We present the more conservative results without the outlier in the model.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The present findings are consistent with the authors' pilot study results.

    “These findings are consistent with our pilot study results (13)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Baseline child anxiety symptom scores were included as a covariate in the intervention effect analyses.

    “Baseline child anxiety symptom scores were included as a covariate in these analyses.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study did not evaluate whether specific intervention components were uniquely responsible for the beneficial outcomes.

    “we did not conduct an evaluation of whether specific intervention components (e.g., relaxation, problem solving) were uniquely responsible for the beneficial outcomes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    One outlier in the information-monitoring group was identified on the 6-month clinical severity rating, with a score of 35 compared with scores of 18 or less for all others.

    “One outlier, in the information-monitoring group, was identified on the clinical severity rating of the Anxiety Disorders Interview Schedule at the 6-month follow-up (outlier score, 35, compared with scores ≤18 for all others).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The finding that parental trait anxiety did not moderate outcomes is consistent with anxiety treatment trials.

    “Consistent with anxiety treatment trials (31), parental trait anxiety level was not found to moderate outcomes”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31]

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Because the sample consisted of volunteers from predominantly Caucasian, two-parent families with relatively high incomes, the findings may not generalize to nonvolunteers or to a more racially or economically diverse population.

    “Our sample was made up of volunteers from predominantly Caucasian, two-parent families with relatively high incomes, and the findings may not generalize to nonvolunteers or to a more racially or economically diverse population.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The Anxiety Disorders Interview Schedule is a well-validated, gold-standard instrument for diagnosing anxiety disorders.

    “The Anxiety Disorders Interview Schedule is the gold-standard assessment tool for determining anxiety disorders and is well validated (16, 17).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [16]

      Not checked in the free run.

    • cites [17]

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Study design and conductown data

    Intervention adherence was assessed on 25% of recorded sessions, and the mean adherence rating across all sessions was 97.58%, indicating high clinician adherence.

    “The average adherence ratings per family ranged from 86.36% to 100%, and the mean adherence rating across all sessions was 97.58% (SD= 3.51), reflecting high levels of clinician adherence.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The intervention was based on cognitive-behavioral strategies for anxious children and on Beardsley's prevention program for children of depressed parents.

    “The intervention was grounded in cognitive-behavioral strategies for pediatric anxious youths (11) and Beardsley’s prevention program for offspring of depressed parents (12).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [11]

      Not checked in the free run.

    • cites [12]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Data from family-based treatment studies of anxious youths suggest that including parents in treatment leads to positive outcomes.

    “This is consistent with data from family-based treatment studies of anxious youths, which suggest that including parents in treatment leads to positive outcomes (32).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32]

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Interpretationcitation

    The finding that 31% of the control group developed an anxiety disorder within 12 months replicates the pilot study data and underscores the vulnerability of offspring of anxious parents.

    “This finding also replicates our pilot study data (13), underscores the vulnerability of offspring of anxious parents”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The follow-up period was limited to 12 months, and a longer follow-up is needed to assess mental health outcomes and the balance of costs and benefits.

    “the length of the follow-up was limited to 12 months; a longer follow-up is needed to further assess mental health outcomes and the balance of costs and benefits.”
    Quote in the paperNot a substantial claim
35 of 35

  • The paper relies on this without support.

    The difference between the intervention and control groups is not attributable to greater therapist time and attention in the intervention condition.

    “the information-monitoring condition did not control for therapist time and attention.”

  • The paper relies on this without support.

    Missing outcome data are missing at random, so full-information maximum-likelihood estimation yields unbiased estimates of intervention effects.

    “Intention-to-treat analyses were performed in Mplus, version 7.11 (25), using full-information maximum-likelihood estimation to handle missing data.”

  • The paper relies on this without support.

    The mediation analysis assumes no unmeasured confounding between the mediators (parental modeling of anxiety and parental global distress) and child anxiety outcomes.

    “Mediation analyses revealed that significant reductions in both parental modeling of anxiety and parental global distress (but not anxiety alone) at the postintervention and 6-month follow-up assessments significantly mediated the intervention effects on outcomes for severity of child anxiety symptoms at the 1-year follow-up”

  • The paper relies on this without support.

    Differential attrition between the intervention and control groups does not bias the intervention effect estimates.

    “There were also group differences in the attrition rate, with significantly more children in the intervention condition failing to complete the 1-year assessment within the allotted window (p=0.03; see the CONSORT diagram in the online data supplement).”
4 of 4

Claims other papers make about this one

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Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Reported total session attendance exceeds the sum of its components

    Minor

    The mean attendance of 6.63 regular sessions plus 1.2 booster sessions is 7.83 sessions, not the reported total mean of 9.01.

    Reported 9.01 · recomputed 7.83

1 of 1

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Authors
Ginsburg, G. S., Drake, K. L., Tein, J.-Y., Teetsel, R., & Riddle, M. A.
Affiliations
  • University of Connecticut (US)
  • Johns Hopkins University (US)
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2015-12
Volume
172
Issue
12
Pages
1207-1214
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/appi.ajp.2015.14091178
PMC
PMC6013063
OpenAlex
W2097013960
Cited by
162
References
32
Citations by year
2026: 3 · 2025: 10 · 2024: 9 · 2023: 7 · 2022: 17 · 2021: 16 · 2020: 54 · 2019: 11 · 2018: 10 · 2017: 9 · 2016: 15 · 2015: 1
FWCI
14.49
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (K24MH096760, R01MH077312)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Keywords
anxiety disorders, childhood anxiety, family intervention, prevention, parental anxiety, parental distress, anxiety symptom severity, psychosocial interventions, moderation
MeSH terms
Adolescent, Anxiety Disorders, Child, Family Therapy, Female, Humans, Male, Child of Impaired Parents, Treatment Outcome

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