Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis

Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis

Authors
Zhou, X. Hetrick, S. E. Cuijpers, P. Qin, B. Barth, J. Whittington, C. J. Cohen, D. Del Giovane, C. Liu, Y. Michael, K. D. Zhang, Y. Weisz, J. R. Xie, P.
Year
2015
Journal
World Psychiatry
Volume
14
Pages
207-22
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. Copyright © 2015 World Psychiatric Association.

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Type of intervention

Treatment and Child Welfare Interventions

Topic

Mental Health Problems and Disorders

Emotional Problems

Depression and Depressed Mood

Intervention

Psychological Treatments

Family Therapy

Cognitive Behavioral Therapy, Behavioral Therapy and Cognitive Therapy

Play Therapy

Psychodynamic/Interpersonal Therapy

Age group

School Aged Children (6-12 years)

Adolescents (13-18 years)

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