PHILADELPHIA – Penn Medicine researchers found that patients who did not respond to cognitive behavioral therapy (CBT) for anxiety in childhood had more chronic and enduring patterns of suicidal ideation at 7 to 19 years after treatment. This study adds to the literature that suggests that successful CBT for childhood anxiety confers long-term benefits. The complete study is available in the Journal of the American Academy of Child & Adolescent Psychiatry.

“This study underscores the importance of the identification and evidence-based treatment of youth anxiety,” says lead author, Courtney Benjamin Wolk, PhD, a postdoctoral researcher at the Center for Mental Health Policy and Services Research at the Perelman School of Medicine at the University of Pennsylvania.

The relationship between anxiety disorders in children and adolescents and the emergence of later depressive disorders is well established. But, few studies have established evidence for an independent relationship between anxiety and the range of suicidal behaviors, including suicidal ideation, plans, attempts and completed suicides or the impact of CBT treatment for anxiety in childhood and adolescent years on later suicidality. CBT is a form of psychotherapy that has been scientifically tested and is the gold standard in the treatment of anxiety and related disorders.

Wolk and colleagues looked at 66 patients who were treated for anxiety, particularly separation, social or generalized anxiety, as children, who agreed to be followed for years after treatment. These individuals had previously participated in two of the seminal randomized controlled trials of the Coping Cat program, a manualized CBT intervention for child anxiety, developed by coauthor Philip C. Kendall, PhD, of Temple University. Forty patients were classified as responding “successfully” to CBT treatment in childhood and adolescent years while 26 were treatment non-responders, with “successful” treatment defined as those patients whose primary anxiety disorder was no longer clinically significant after 16 weeks of treatment.

At seven to 19 years after treatment, treatment response was found to significantly predict lifetime suicidal ideation, such that treatment nonresponders were more likely to have experienced suicidal ideation. In fact, every patient who reported thinking about suicide in the past 12 months or past two weeks was among those who had not responded to CBT. Eighteen of these reported experiencing suicidal ideation, nine reported having made one or more suicide plans and six described making one or more suicide attempts in their lifetime.

In those patients who reported suicidal ideation, onset occurred at a mean age of about 16 years and was last reported by most patients at about 20 years of age. Mean ages of onset and recency for suicide plans were 18 and 19 years, respectively. Finally, among those who reported making suicide attempts, ideation began at a mean of 17 years and occurred most commonly/recently at the age of 21. All instances of suicidal plans and attempts reported occurred after the age of initial treatment.

This is the longest known study looking at suicidal ideation following CBT treatment in youth. “This study suggests the importance of ongoing monitoring of anxious youth who are not successfully treated for later suicidal ideation,” says senior author, Rinad Beidas, PhD, assistant professor at the Center for Mental Health Policy and Services Research at the Perelman School of Medicine at the University of Pennsylvania. It is the first study to demonstrate the protective function of successful evidence-based treatment for childhood anxiety disorders on suicidal ideation in late adolescence and adulthood.