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Comorbid Anxiety and Depressive Symptoms in Children and Adolescents

A Systematic Review and Analysis


Journal of Psychiatric Practice®: March 2016 - Volume 22 - Issue 2 - p 84–98
doi: 10.1097/PRA.0000000000000132

Background: A large and extensive body of research has examined comorbid anxiety and depression in adults. Children and adolescents also frequently present with comorbid anxiety and depression; however, research and treatment require unique environmental and neurodevelopmental considerations in children. As a result, our understanding of comorbid anxiety and depression in children and adolescents is limited.

Objective: The goal of this systematic review was to examine the current literature focused on comorbid anxiety and depression in children and adolescents. The review included theoretical conceptualizations as well as diagnostic, neurobiological, prevention, and treatment considerations. In addition, a proposed algorithm for the treatment of comorbid anxiety and depression in children/adolescents is provided.

Methods: This systematic literature review included 3 discrete searches in Ovid SP Medline, PsycInfo, and PubMed.

Results: The review included and synthesized 115 articles published between 1987 and 2015. The available evidence suggests that anxiety and depression are common in clinical populations of children and adolescents, and that comorbidity is likely underestimated in children and adolescents. Children and adolescents with comorbid anxiety and depression have unique presentations, greater symptom severity, and treatment resistance compared with those who have either disease in isolation. A dimensional approach may be necessary for the future development of diagnostic strategies and treatments for this population. Nascent neuroimaging work suggests that anxiety and depression each represents a distinct neurobiological phenotype.

Conclusions: The literature that is currently available suggests that comorbid anxiety and depression is a common presentation in children and adolescents. This diagnostic picture underscores the importance of comprehensive dimensional assessments and multimodal evidence-based approaches given the high disease severity. Future research on the neurobiology and the treatment of these common clinical conditions is warranted.

MELTON: Therapy Dallas, Dallas, TX

CROARKIN: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN

STRAWN: Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH

MCCLINTOCK: Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX

Supported in part by the National Institute of Mental Health [K23 MH087739 (S.M.M.), K23 MH106037 (J.R.S.), and K23 MH100266 (P.E.C.)].

The authors declare no conflicts of interest.

Please send correspondence to: Tabatha H. Melton, PhD, Therapy Dallas, 12800 Hillcrest Rd, Suite A124, Dallas, TX 75230 (e-mail:

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.