Authors: Lucy Nguyen, Michelle Alder, Natoshia Cunningham

Michigan State University, College of Human Medicine, Department of Family Medicine

Abstract Title: Assessing the Influence of ADAPT on Comorbid Anxiety and Depressive Disorders.

Background: Functional abdominal pain disorders (FAPD) are common chronic pain conditions impacting more than 10% of youth and are associated with adverse outcomes. A tailored approach to care addressing both pain and comorbid anxiety called the Aim to Decrease Anxiety and Pain Treatment (ADAPT) has been shown to improve pain-related impairment in youth with FAPD. In this secondary analysis of the ADAPT RCT, we explored how specific mental health diagnoses MDD, GAD, social anxiety, separation anxiety, panic disorder, and OCD responded following ADAPT.

Methods: Participants, between the ages of 9-14 diagnosed with FAPD, underwent a diagnostic interview (ADIS for DSM-IV, Child Version ADIS-IV). Participants were then randomized to continue treatment as usual with additional tailored cognitive behavioral therapy (ADAPT +TAU), or TAU alone. A post-assessment to assess the outcomes was done 8 weeks later. This secondary analysis is focused on participants who completed ADAPT (n=39). SPSS was utilized for data analysis. Chi-squares using Fischer’s exact tests were used to assess significant differences between the incidence of anxiety diagnoses before and after receiving ADAPT.

Results: The number of people with GAD diagnoses significantly decreased from 20 to 10 individuals after ADAPT treatment (p < 0.001). The number of people with social anxiety diagnosis prior to ADAPT treatment was 20, which decreased significantly to 10 at the post-assessment (p<0.001). The number of people with a SAD diagnosis pretreatment was 13 which then dropped to 4 (p = 0.009). The number of people with a panic disorder diagnosis dropped from 4 to 2 (not significant). The number of OCD diagnosis from pre- to post-assessment significantly decreased from 7 to 3 (p = 0.004).

For each depressive disorder, dysthymia and MDD, the number of depressive diagnoses in the treatment as usual group increased at the end of assessment. For those diagnosed with dysthymia in the ADAPT group, the number did not change (not significant). The number of people with MDD diagnoses dropped from 5 to 2 after ADAPT treatment (p = 0.013).

Conclusion: Youths with FAPD and who received ADAPT demonstrated statistically significant improvement in mental health diagnoses including, major depression, dysthymia, generalized anxiety, social anxiety, separation anxiety, and OCD. CBT is often underutilized in the treatment of youth with chronic medical conditions. When addressing pain, co-occurring anxiety and depression is often overlooked although it is common and associated with poor outcomes. CBT should continue to be researched and promoted for symptom management for chronic medical issues with co-occurring psychological disorders.