A Meta-analytic Review: Psychological Treatment of Subthreshold Depression in Children and Adolescents

P. Cuijpers; B.S. Pineda; M.Y. Ng; J.R. Weisz; R.F. Muñoz; C. Gentili; S. Quero; E. Karyotaki

doi:10.1016/j.jaac.2020.11.024

A Meta-analytic Review: Psychological Treatment of Subthreshold Depression in Children and Adolescents

P. Cuijpers, B.S. Pineda, M.Y. Ng, J.R. Weisz, R.F. Muñoz, C. Gentili, S. Quero, E. Karyotaki

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Objective: Subthreshold depression has been found to be associated with considerable impairment and an increased risk of developing major depression. Although several randomized trials have examined the effects of psychological interventions for subthreshold depression in children and adolescents, no meta-analysis has integrated the results of these trials.

Method: We searched 4 bibliographic databases and included randomized trials comparing psychological interventions with control conditions in children and adolescents scoring above a cut-off of a depression questionnaire but not meeting diagnostic criteria for major depression (or persistent depressive disorder) according to a diagnostic interview. Effect sizes and incidence rates of major depression were pooled with random effects meta-analyses.

Results: A total of 12 trials with 1,576 children and adolescents met inclusion criteria. The overall effect size indicating the difference between treatment and control at post-test was g = 0.38 (95% CI = 0.14–0.63), which corresponds to a number-needed-to-treat (NNT) of 8.4. Heterogeneity was moderate to high (I2 = 61; 95% CI = 28–79), and there was significant risk of publication bias (p < .04). The 2 studies in children less than 12 years of age showed nonsignificant effects (g = 0.01; 95% CI = –1.16 to 1.18). We found no significant effect on the incidence of major depression at follow-up (relative risk = 0.52; 95% CI = 0.25–1.08), although this may be related to low statistical power.

Conclusion: Interventions for subthreshold depression may have positive acute effects in adolescents. There is currently insufficient evidence, however, that these interventions are effective in children less than 12 years of age, or that they prevent the onset of major depression at follow-up.

Original language	English
Pages (from-to)	1072-1084
Number of pages	13
Journal	Journal of the American Academy of Child and Adolescent Psychiatry
Volume	60
Issue number	9
Early online date	14 Feb 2021
DOIs	https://doi.org/10.1016/j.jaac.2020.11.024
Publication status	Published - Sept 2021

Bibliographical note

Funding

Disclosure: Dr. Cuijpers has reported support for unrelated grants from the European Commission, the Netherlands Organisation for Health Research and Development (ZonMw), and for being Chair of the Mental Health Priority Area of the Wellcome Trust in London, United Kingdom. He has received royalties for books and for occasional workshops and invited addresses. Dr. Ng has reported support from an unrelated fellowship funded through the National Institute of Mental Health (NIMH). Dr. Weisz has reported support from unrelated grants from the Institute of Education Science, US Department of Education, the Norlien Foundation, the Templeton Foundation, the United Health Group, and NIMH. He has received royalties for books and payments for invited addresses and workshops. Dr. Muñoz has reported support from unrelated grants from the National Institutes of Health (NIH) and for being Co-Chair of the Community Engagement Alliance (CEAL) project of the NIH. He has received royalties from books and payments for invited addresses. Dr. Gentili has reported support for unrelated grants from the European Commission (as local coordinator of the FET POTION Project H2020 and from the Italian Ministry of Education, University and Research (MIUR) as PI of the Progetti di Ricerca di Interesse Nazionale project TRAINED. Dr. Quero has reported unrelated support by Centro de Investigación Biomédica en Red - Fisiopatología de la Obesidad y Nutrición (CIBEROBN), an initiative of El Instituto de Salud Carlos III (ISCIII CB06 03/0052). Dr. Karyotaki has reported unrelated grant support by the Netherlands Organization for Health Research and Development (NWO; project number 019.182SG.001). Dr. Pineda has reported no biomedical financial interests or potential conflicts of interest. The authors have reported no funding for this work.

Funders	Funder number
Norlien Foundation
United Health Group
Wellcome Trust in London
National Institutes of Health	H2020
National Institute of Mental Health
U.S. Department of Education
John Templeton Foundation
Institute of Education Sciences
European Commission
ZonMw
Nederlandse Organisatie voor Wetenschappelijk Onderzoek	019.182SG.001
Ministero dell’Istruzione, dell’Università e della Ricerca
Instituto de Salud Carlos III	CB06 03/0052
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 10 Reduced Inequalities

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title = "A Meta-analytic Review: Psychological Treatment of Subthreshold Depression in Children and Adolescents",

abstract = "Objective: Subthreshold depression has been found to be associated with considerable impairment and an increased risk of developing major depression. Although several randomized trials have examined the effects of psychological interventions for subthreshold depression in children and adolescents, no meta-analysis has integrated the results of these trials. Method: We searched 4 bibliographic databases and included randomized trials comparing psychological interventions with control conditions in children and adolescents scoring above a cut-off of a depression questionnaire but not meeting diagnostic criteria for major depression (or persistent depressive disorder) according to a diagnostic interview. Effect sizes and incidence rates of major depression were pooled with random effects meta-analyses. Results: A total of 12 trials with 1,576 children and adolescents met inclusion criteria. The overall effect size indicating the difference between treatment and control at post-test was g = 0.38 (95\% CI = 0.14–0.63), which corresponds to a number-needed-to-treat (NNT) of 8.4. Heterogeneity was moderate to high (I2 = 61; 95\% CI = 28–79), and there was significant risk of publication bias (p < .04). The 2 studies in children less than 12 years of age showed nonsignificant effects (g = 0.01; 95\% CI = –1.16 to 1.18). We found no significant effect on the incidence of major depression at follow-up (relative risk = 0.52; 95\% CI = 0.25–1.08), although this may be related to low statistical power. Conclusion: Interventions for subthreshold depression may have positive acute effects in adolescents. There is currently insufficient evidence, however, that these interventions are effective in children less than 12 years of age, or that they prevent the onset of major depression at follow-up.",

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AU - Ng, M.Y.

AU - Weisz, J.R.

AU - Muñoz, R.F.

AU - Gentili, C.

AU - Quero, S.

AU - Karyotaki, E.

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AB - Objective: Subthreshold depression has been found to be associated with considerable impairment and an increased risk of developing major depression. Although several randomized trials have examined the effects of psychological interventions for subthreshold depression in children and adolescents, no meta-analysis has integrated the results of these trials. Method: We searched 4 bibliographic databases and included randomized trials comparing psychological interventions with control conditions in children and adolescents scoring above a cut-off of a depression questionnaire but not meeting diagnostic criteria for major depression (or persistent depressive disorder) according to a diagnostic interview. Effect sizes and incidence rates of major depression were pooled with random effects meta-analyses. Results: A total of 12 trials with 1,576 children and adolescents met inclusion criteria. The overall effect size indicating the difference between treatment and control at post-test was g = 0.38 (95% CI = 0.14–0.63), which corresponds to a number-needed-to-treat (NNT) of 8.4. Heterogeneity was moderate to high (I2 = 61; 95% CI = 28–79), and there was significant risk of publication bias (p < .04). The 2 studies in children less than 12 years of age showed nonsignificant effects (g = 0.01; 95% CI = –1.16 to 1.18). We found no significant effect on the incidence of major depression at follow-up (relative risk = 0.52; 95% CI = 0.25–1.08), although this may be related to low statistical power. Conclusion: Interventions for subthreshold depression may have positive acute effects in adolescents. There is currently insufficient evidence, however, that these interventions are effective in children less than 12 years of age, or that they prevent the onset of major depression at follow-up.

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A Meta-analytic Review: Psychological Treatment of Subthreshold Depression in Children and Adolescents

Abstract

Bibliographical note

Funding

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