The effects of psychological treatments of depression in children and adolescents on response, reliable change, and deterioration: a systematic review and meta-analysis

Pim Cuijpers*, Eirini Karyotaki, Marketa Ciharova, Clara Miguel, Hisashi Noma, Yvonne Stikkelbroek, John R. Weisz, Toshi A. Furukawa

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)177-192
Number of pages16
JournalEuropean Child and Adolescent Psychiatry
Volume32
Issue number1
Early online date6 Oct 2021
DOIs
Publication statusPublished - Jan 2023

Bibliographical note

Publisher Copyright:
© 2021, The Author(s).

Keywords

  • Cognitive behaviour therapy
  • Depression
  • Major depressive disorder
  • Meta-analysis
  • Psychotherapy

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