TY - JOUR
T1 - The effects of psychological treatments of depression in children and adolescents on response, reliable change, and deterioration
T2 - a systematic review and meta-analysis
AU - Cuijpers, Pim
AU - Karyotaki, Eirini
AU - Ciharova, Marketa
AU - Miguel, Clara
AU - Noma, Hisashi
AU - Stikkelbroek, Yvonne
AU - Weisz, John R.
AU - Furukawa, Toshi A.
N1 - Publisher Copyright:
© 2021, The Author(s).
PY - 2023/1
Y1 - 2023/1
N2 - Meta-analyses show that psychotherapies are effective in the treatment of depression in children and adolescents. However, these effects are usually reported in terms of effect sizes. For patients and clinicians, it is important to know whether patients achieve a clinically significant improvement or deterioration. We conducted such a meta-analysis to examine response, clinically significant change, clinically significant deterioration and recovery as outcomes. We searched four bibliographic databases and included 40 randomised trials comparing psychotherapy for youth depression against control conditions. We used a validated method to estimate outcome rates, based on means, standard deviation and N at baseline and post-test. We also calculated numbers-need-to- treat (NNT). The overall response rate in psychotherapies at 2 (±1) months after baseline was 39% (95% CI: 34–45) and 24% (95% CI: 0.19–28) in control conditions (NNT: 6.2). The difference between therapy and control was still significant at 6–12 months after baseline (NNT=7.8). Clinically significant improvement was found in 54% of youth in therapy, compared with 32% in control groups (NNT=5.3); clinically significant deterioration was 6% in therapy, 13% in controls (NNT=5.1); recovery was 58% in therapy, 36% in controls (NNT=3.3). Smaller effects were found in studies with low risk of bias. Psychotherapies for depression in youth are effective compared to control conditions, but more than 60% of youth receiving therapy do not respond. More effective treatments and treatment strategies are clearly needed. Trial registrationhttps://osf.io/84xka.
AB - Meta-analyses show that psychotherapies are effective in the treatment of depression in children and adolescents. However, these effects are usually reported in terms of effect sizes. For patients and clinicians, it is important to know whether patients achieve a clinically significant improvement or deterioration. We conducted such a meta-analysis to examine response, clinically significant change, clinically significant deterioration and recovery as outcomes. We searched four bibliographic databases and included 40 randomised trials comparing psychotherapy for youth depression against control conditions. We used a validated method to estimate outcome rates, based on means, standard deviation and N at baseline and post-test. We also calculated numbers-need-to- treat (NNT). The overall response rate in psychotherapies at 2 (±1) months after baseline was 39% (95% CI: 34–45) and 24% (95% CI: 0.19–28) in control conditions (NNT: 6.2). The difference between therapy and control was still significant at 6–12 months after baseline (NNT=7.8). Clinically significant improvement was found in 54% of youth in therapy, compared with 32% in control groups (NNT=5.3); clinically significant deterioration was 6% in therapy, 13% in controls (NNT=5.1); recovery was 58% in therapy, 36% in controls (NNT=3.3). Smaller effects were found in studies with low risk of bias. Psychotherapies for depression in youth are effective compared to control conditions, but more than 60% of youth receiving therapy do not respond. More effective treatments and treatment strategies are clearly needed. Trial registrationhttps://osf.io/84xka.
KW - Cognitive behaviour therapy
KW - Depression
KW - Major depressive disorder
KW - Meta-analysis
KW - Psychotherapy
UR - http://www.scopus.com/inward/record.url?scp=85116453625&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85116453625&partnerID=8YFLogxK
U2 - 10.1007/s00787-021-01884-6
DO - 10.1007/s00787-021-01884-6
M3 - Article
C2 - 34611729
AN - SCOPUS:85116453625
SN - 1018-8827
VL - 32
SP - 177
EP - 192
JO - European Child and Adolescent Psychiatry
JF - European Child and Adolescent Psychiatry
IS - 1
ER -