Psychotherapy for depression among children and adolescents: a systematic review

Abstract

Objective: To examine the clinical benefit, the harm and the cost‐effectiveness of psychotherapies in comparison with no treatment, waiting‐list controls, attention‐placebos, and treatment as usual in depressed youths. Method: Meta‐analyses were undertaken by using data from all relevant randomized‐controlled trials identified by a comprehensive literature search. The primary outcome was relative risk (RR) of response. Results: We identified 27 studies containing 35 comparisons and 1744 participants. At post‐treatment, psychotherapy was significantly superior (RR = 1.39, 95% CI 1.18–1.65, P = 0.0001, number‐needed to treat 4.3). There was an evidence of the existence of small study effects, including a publication bias (P < 0.001). The superiority of psychotherapy was no longer statistically significant (1.18 [0.94–1.47], P = 0.15) at 6‐month follow‐up. None of the studies reported adverse effects or cost‐effectiveness outcomes. Conclusion: Although the findings were biased by some small positive trials, psychotherapies appear to help depressed youths for the short term, but are no longer significantly favourable at 6‐month follow‐up.