11.15 Problem-Solving Training as an Active Ingredient for Treating Youth Depression? A Mixed-Methods Scoping Review Involving Youth Co-Researchers

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Many youth with depression leave treatment without reliable symptom improvement. One important avenue for enhancing impact is to prioritize the most effective treatment ingredients. A promising candidate is problem-solving training (PST), which has demonstrated effectiveness in adult depression. We conducted a scoping review to map the available evidence regarding its effectiveness in youth aged 14 to 24 years old and involved youth as co-researchers. We systematically searched 5 bibliographic databases (APA PsycINFO, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Embase, MEDLINE, Web of Science) for secondary analyses of trial data exploring associations between problem solving and treatment response in broader therapies, and for randomized controlled trials of stand-alone PST. Records were subject to systematic screening, data extraction, and charting. An exploratory meta-analysis examined the overall effect of stand-alone PST. Two youth co-researchers and a youth coordinator supported the interpretation and contextualization of review findings, collected inputs from a youth advisory panel, and co-designed dissemination materials. After screening 563 records, we included 4 secondary analyses and 4 randomized controlled trials of stand-alone PST. Secondary analyses suggested that improved problem solving might enhance outcomes of CBT, but the original trials were not powered for such analyses. The evidence base relating to stand-alone PST was found to be of low quality. The exploratory meta-analysis showed a small and nonsignificant effect on self-reported depression symptoms (Hedges’ g = –0.34; 95% CI, –0.92 to 0.23) with high heterogeneity. The only randomized controlled trial with a low risk of bias found that PST helped youth solve problems but was not significantly more effective than the control at reducing emotional symptoms. Dropout rates were high (41.4% to 72.7%) in 2 of the 4 PST trials. Our findings suggest PST may be beneficial for youth who face challenging problems but whose depressive symptoms are relatively mild. Those who are moderately or severely depressed may require more in-depth support. Youth co-researchers and advisors stressed that PST must be youth-driven, strengths-based, comprehensive, and personalized to meet youth needs. Additional research is needed to understand when and for whom PST is most effective.