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Cognitive-Behavioral Therapy for Child Anxiety Confers Long-Term Protection From Suicidality

Doi : 10.1016/j.jaac.2014.12.004 

Courtney Benjamin Wolk a  , Philip C. Kendall b, Rinad S. Beidas a

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Evidence for an independent relationship between anxiety and suicidality has been mixed. Few studies have examined this relationship in youth seeking treatment for anxiety. The present study examined the relationship between response to treatment for an anxiety disorder in childhood and suicidal ideation, plans, and attempts at a follow-up interval of 7 to 19 years. We hypothesized that successful treatment for an anxiety disorder in childhood would be protective against later suicidality.


The present study was a 7- to 19-year (mean = 16.24 years; SD = 3.56 years) follow-up study. Adults (N = 66) completed cognitive-behavioral treatment (CBT) for anxiety as children. Information regarding suicidality at follow-up was obtained via the World Mental Health Survey Initiative version of the World Health Organization Composite International Diagnostic Interview (CIDI) and the Beck Depression Inventory–II (BDI-II).


Results indicate that participants who responded favorably to CBT during childhood were less likely to endorse lifetime, past-month, and past–2-week suicidal ideation than treatment nonresponders. This was consistent across self-report and interview-report of suicidal ideation. Treatment response was not significantly associated with suicide plans or attempts, although the infrequent occurrence of both limited the ability to detect findings.


Results suggest more chronic and enduring patterns of suicidal ideation among individuals with anxiety in childhood that is not successfully treated. This study adds to the literature that suggests that successful CBT for childhood anxiety confers long-term benefits and underscores the importance of the identification and evidence-based treatment of youth anxiety.

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Key Words : anxiety, suicide, suicidality, cognitive-behavioral therapy, evidence-based treatment


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 The initial randomized controlled trials from which participants were drawn for the present follow-up study were supported by National Institute of Mental Health (NIMH) grants to P.C.K. (MH44042; MH64484). The design, conduct of the study, data collection, and management were supported by an NIMH grant to C.B.W. (MH086954). C.B.W. (MH103955), R.S.B. (MH099179), and P.C.K. (MH86438; MH63747) were supported by NIMH grants during the analysis, interpretation, and preparation of the present manuscript. Additionally, the preparation of this article was supported in part by the Implementation Research Institute (IRI) at the George Warren Brown School of Social Work, Washington University in St. Louis; through an award from NIMH (R25 MH080916) and Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs Contract, Veterans Health Administration, Office of Research and Development, Health Services Research and Development Service. Dr. Beidas was an IRI fellow from 2012-2014.
 Disclosure: Dr. Kendall has received royalties from the sale of materials regarding the treatment of anxiety in youth, and his spouse has received payment from and has an interest in the publisher of these materials. Dr. Beidas has received royalties from Oxford University Press and has served as a consultant for Kinark Child and Family Services. Dr. Wolk reports no biomedical financial interests or potential conflicts of interest.

© 2015  American Academy of Child and Adolescent Psychiatry. Publié par Elsevier Masson SAS. Tous droits réservés.
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