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With the development of empirically supported treatments over the decades, have youth psychotherapies grown stronger? To investigate, we examined changes over time in treatment effects for four frequently treated youth mental-health problems: anxiety, depression, attention-deficit hyperactivity disorder (ADHD), and conduct disorders. We used PubMed and PsycINFO to search for randomized controlled trials (RCTs) that were published between January 1960 and May 2017 involving youths between the ages of 4 and 18 years. We also searched reviews and meta-analyses of youth psychotherapy research, followed reference trails in the reports we identified, and obtained additional studies identified by therapy researchers whom we contacted. We identified 453 RCTs (31,933 participants) spanning 53 years (1963–2016). Effect sizes for the problem-relevant outcome measures were synthesized via multilevel meta-analysis. We tracked temporal trends for each problem domain and then examined multiple study characteristics that might moderate those trends. Mean effect size increased nonsignificantly for anxiety, decreased nonsignificantly for ADHD, and decreased significantly for depression and conduct problems. Moderator analyses involving multiple study subgroups showed only a few exceptions to these surprising patterns. The findings suggest that new approaches to treatment design and intervention science may be needed, especially for depression and conduct problems. We suggest intensifying the search for mechanisms of change, making treatments more transdiagnostic and personalizable, embedding treatments within youth ecosystems, adapting treatments to the social and technological changes that alter youth dysfunction and treatment needs, and resisting old habits that can make treatments unduly skeuomorphic.
Objective: Youth depression is a debilitating condition that constitutes a major public health concern. A 2006 meta-analysis found modest benefits for psychotherapy vs. control. Has 13 more years of research improved that picture? We sought to find out.
Method:We searched PubMed, PsychINFO, and Dissertation Abstracts International for 1960-2017, identifying 655 randomized, English-language psychotherapy trials for ages 4-18 years. Of these, 55 assessed psychotherapy versus control for youth depression with outcome measures administered to both treatment and control conditions at post (k=53) and/or follow-up (k=32). Twelve study and outcome characteristics were extracted, and effect sizes were calculated for all psychotherapy vs. control comparisons. Using a threelevel random-effects model, we obtained an overall estimate of the psychotherapy vs. control difference while accounting for the dependency among effect sizes. We then fitted a three-level mixed-effects model to identify moderators that might explain variation in effect size within and between studies.Results: Overall effect size (g) was 0.36 at posttreatment, 0.21 at follow-up (averaging 42 weeks after post-treatment). Three moderator effects were identified: effects were significantly larger for Interpersonal Therapy than CBT, for youth self-reported outcomes than parent-reports, and for comparisons with inactive control conditions (e.g., waitlist) than active controls (e.g., usual care). Effects showed specificity, with significantly smaller effects for anxiety and externalizing behavior outcomes than for depression measures.
Conclusion:Youth depression psychotherapy effects are modest, with no significant change over the past 13 years. The findings highlight the need for treatment development Running Head: PSYCHOTHERAPY FOR YOUTH DEPRESSION 3 and research to improve both immediate and longer-term benefits.
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