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J Am Acad Child Adolesc Psychiatry. 2015 Mar;54(3):175-9. doi: 10.1016/j.jaac.2014.12.004. Epub 2014 Dec 17.

Cognitive-behavioral therapy for child anxiety confers long-term protection from suicidality.

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Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Electronic address:
Child and Adolescent Anxiety Disorders Clinic, Temple University, Philadelphia.
Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia.



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.


anxiety; cognitive-behavioral therapy; evidence-based treatment; suicidality; suicide

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