Abstract
Previous meta-analyses of psychotherapies for child and adolescent depression were limited because of the small number of trials with direct comparisons between two treatments. A network meta-analysis, a novel approach that integrates direct and indirect evidence from randomized controlled studies, was undertaken to investigate the comparative efficacy and acceptability of psychotherapies for depression in children and adolescents. Systematic searches resulted in 52 studies (total N=3805) of nine psychotherapies and four control conditions. We assessed the efficacy at post-treatment and at follow-up, as well as the acceptability (all-cause discontinuation) of psychotherapies and control conditions. At post-treatment, only interpersonal therapy (IPT) and cognitive-behavioral therapy (CBT) were significantly more effective than most control conditions (standardized mean differences, SMDs ranged from -0.47 to -0.96). Also, IPT and CBT were more beneficial than play therapy. Only psychodynamic therapy and play therapy were not significantly superior to waitlist. At follow-up, IPT and CBT were significantly more effective than most control conditions (SMDs ranged from -0.26 to -1.05), although only IPT retained this superiority at both short-term and long-term follow-up. In addition, IPT and CBT were more beneficial than problem-solving therapy. Waitlist was significantly inferior to other control conditions. With regard to acceptability, IPT and problem-solving therapy had significantly fewer all-cause discontinuations than cognitive therapy and CBT (ORs ranged from 0.06 to 0.33). These data suggest that IPT and CBT should be considered as the best available psychotherapies for depression in children and adolescents. However, several alternative psychotherapies are understudied in this age group. Waitlist may inflate the effect of psychotherapies, so that psychological placebo or treatment-as-usual may be preferable as a control condition in psychotherapy trials.
Highlights
Depression in young people has significant developmental implications, and accounts for the greatest burden of disease in this age group [1]
2,361 patients were randomized to nine psychotherapies (CBT, N51149; interpersonal therapy (IPT), N5344; supportive therapy, N5244; cognitive therapy, N5230; family therapy, N5134; play therapy, N5105; behavioral therapy, N576; problem-solving therapy, N544; or psychodynamic therapy, N535)
Our review of 52 randomized controlled trial (RCT) suggests that, among the psychotherapies tested in children and adolescents with depression, only IPT and cognitive-behavioral therapy (CBT) are significantly more beneficial than most control conditions at post-treatment and at follow-up
Summary
Depression in young people has significant developmental implications, and accounts for the greatest burden of disease in this age group [1]. Controversy regarding the efficacy and safety of antidepressant medications, along with the evidence of an increased risk of suicidal behavior in children and adolescents treated with some of these medications, has focused attention on the use of psychotherapy for this young population [17,18,19,20,21]. We implemented a network meta-analysis, a new methodological approach that allows the simultaneous comparison of multiple psychotherapeutic interventions within a single analysis, while preserving randomization [29] This approach was applied to integrate direct evidence (from studies directly comparing interventions) with indirect evidence (information about two treatments derived via a common comparator, e.g. waitlist) to estimate the comparative efficacy and acceptability of all treatments [30]. The aim of the current network meta-analysis was to provide a comprehensive and hierarchical evidence of the efficacy and acceptability of all psychotherapies in the treatment of depression in children and adolescents
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
