Prevalence, outcomes, and effective interventions for anxiety disorders in children and adolescents

Anxiety disorders are common in children and adolescents worldwide and can seriously affect their functioning and well-being. They often continue into adulthood and are linked to other psychiatric problems. Although treatments have improved, significant challenges remain, especially in non-Western regions due to cultural and access barriers.

This systematic narrative review aimed to synthesize international and Persian literature (2005-2024) regarding the prevalence, outcomes, and effectiveness of interventions for anxiety disorders in children and adolescents, with specific attention to the Iranian context.

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, comprehensive searches were conducted across international (PubMed, PsycINFO, Scopus, Cochrane) and Persian (SID, MagIran) databases. Sixty-four studies were included based on predefined eligibility criteria. Data extraction and quality assessment were performed independently by two reviewers, and a narrative synthesis approach was employed due to heterogeneity across studies.

Findings confirm high prevalence and chronicity of anxiety disorders in youth globally and in Iran. Untreated anxiety is consistently linked to academic impairment, social withdrawal, and increased risk for future psychopathology. Cognitive-behavioral therapy (CBT) emerged as the most effective intervention, with response rates of 55-65%, especially when combined with selective serotonin reuptake inhibitors (SSRIs), which further increased success rates to approximately 75-80%. Family-based and school-based interventions also demonstrated efficacy, though cultural adaptation remains limited. Systemic barriers, including provider shortages and stigma, impede care in resource-limited settings such as Iran.

Anxiety disorders in youth constitute a major public health concern requiring culturally sensitive, evidence-based interventions. While CBT and combined treatments are effective, future research should focus on cultural adaptation, innovative delivery models, and system-level solutions to bridge the treatment gap in low- and middle-income countries.