Neighborhood opportunity and response to psychotherapy in anxious youth

Abstract

Early adversity is a well-documented risk factor for anxiety disorders in youth; few studies, however, have examined how exposure to adversity influences treatment outcomes. Emerging research suggests that systemic inequities can affect the efficacy of frontline psychotherapies. The effects of structural disadvantage and, in particular, neighborhood-level features on treatment outcomes for pediatric anxiety are largely under-studied. The current study aimed to examine the impact of neighborhood opportunity on children's response to cognitive behavioral therapy (CBT). A total of 202 youth aged 8-17 years (M_age = 12.030, 56 % F) with a diagnosed anxiety disorder completed 8-12 weeks of exposure-based CBT. Neighborhood disadvantage was quantified using the Child Opportunity Index (COI), and treatment response was measured via the Pediatric Anxiety Rating Scale (PARS) at baseline, post-treatment, and a 6-month follow-up assessment. Following treatment, anxious youth exhibited a significant 31.523 % reduction in symptoms. Across all scoring dimensions of the COI (socioeconomic, education, and health & environment), neighborhood disadvantage did not reliably predict treatment response. These findings suggest that when provided access to high-quality, evidence-based psychotherapy, youth from lower opportunity neighborhoods achieve comparable outcomes to their more advantaged peers. Taken together with prior research, this study suggests that structural disadvantage at the neighborhood level is not a robust predictor of treatment outcomes in the context of pediatric anxiety. These findings raise the possibility that equitable access to treatment could, in certain circumstances, mitigate the negative effects of systemic neighborhood-level inequities on mental health outcomes, underscoring the importance of expanding the availability of treatment services.

Keywords: Anxiety; Cognitive behavioral therapy; Neighborhood disadvantage.