Abstract
BackgroundDepressive disorders are common in adolescence and are associated with a wide range of negative long-term outcomes. Highly controlled randomized controlled trials (RCT) provide considerable evidence for the efficacy of cognitive-behavioral therapy (CBT) as a treatment for depression, but studies examining the effectiveness of CBT in clinical settings are very rare .MethodsIn the present observational study, the changes achieved through routine CBT in adolescents with depressive disorders treated in a clinical setting in terms of a university outpatient clinic were analyzed, and compared to a historical control group of adolescents with depressive disorders who had received treatment as usual. At the start and end of treatment (pre- and post-assessment), parent and self-ratings of the German versions of the Youth Self-Report (YSR), the Child Behavior Checklist (CBCL) and rating scales for depressive symptoms (FBB-DES, SBB-DES) were assessed. A total of 331 adolescents aged 11–18 years with complete data were assessed for the main analysis.ResultsThe analysis yielded small to large pre-post effect sizes (Cohen’s d) for the total sample (d = 0.33 to d = 0.82) and large effect sizes for adolescents who were rated in the clinical range on each (sub) scale at the start of treatment (d = 0.85 to d = 1.30). When comparing patients in the clinical range with historical controls, medium to large net effect sizes (d = 0.53 to d = 2.09) emerged for the total scores in self- and parent rating. However, a substantial proportion of the sample remained in the clinical range at the end of treatment.ConclusionsThese findings suggest that CBT is effective for adolescents with depressive disorders when administered under routine care conditions, but the results must be interpreted with caution due to the lack of a direct control condition.Trial registrationDRKS, DRKS00021518. Registered 27 April 2020 - Retrospectively registered, http://drks.de
Highlights
Depressive disorders are common in adolescence and are associated with a wide range of negative long-term outcomes
It seems clear that an optimal treatment of this group is essential and unsurprisingly, intensive psychotherapy research examining the treatment of depression has been conducted over the last decades
Participants Participants were included in this study according to the following criteria:: (1) age 11–18 years, (2) fulfillment of the ICD-10 criteria for any depressive disorder, (3) clinically relevant impairment based on clinical judgment, (4) ability to attend treatment appointments once per week, and (5) a positive prognosis for outpatient treatment
Summary
Depressive disorders are common in adolescence and are associated with a wide range of negative long-term outcomes. Depression in adolescence increases the risk of negative long-term outcomes, such as poor physical health, social isolation and poor vocational attainment and achievement (i.e., [6]). It seems clear that an optimal treatment of this group is essential and unsurprisingly, intensive psychotherapy research examining the treatment of depression has been conducted over the last decades. Such studies have been aggregated into systematic reviews and meta-analyses demonstrating the efficacy of cognitive-behavioral therapy (CBT) (i.e., [7,8,9,10]). International guidelines consistently recommend CBT and interpersonal therapy (IPT) as the first-line treatment for depression in young people [12, 13]
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