Effects of psychotherapy for depression in children and adolescents: A meta-analysis.

Abstract

Serious sequelae of youth depression, plus recent concerns over medication safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g., cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity (externalizing problems were not), plus short-but not long-term holding power. Youth depression treatments appear to produce effects that are significant but modest in their strength, breadth, and durability. Keywords depression; children; adolescents; psychotherapy; meta-analysis Depression in children and adolescents (herein referred to collectively as youths) is a significant, persistent, and recurrent public health problem that undermines social and school functioning, generates severe family stress, and prompts significant use of mental health services (Angold et al., 1998;Clarke, DeBar, & Lewinsohn, 2003). Youth depression is also linked to increased risk of other psychiatric disorders (Angold & Costello, 1993) as well as drug use and suicide (Gould et al., 1998;Rohde, Lewinsohn, & Seeley, 1991), which is the third most common cause of death among adolescents (Arias, MacDorman, Strobino, & Guyer, 2003). Relapse rates have been reported at 12% within 1 year and 33% within 4 years (Lewinsohn, Clarke, Seeley, & Rohde, 1994), and by the age of 18 years, some 20% of youths will have met criteria for a diagnosis of major depressive disorder at least once (Birmaher et al., 1996). Prospective longitudinal research has shown substantial continuity of youth depression into adulthood, with impaired functioning in work, social, and family life, and markedly elevated risk of adult suicide attempts and completed suicide (see, e.g., Costello et al., 2002;Weissman et al., 1999). The extent, impact, and long-term sequelae of youth depression underscore the need for effective treatment. A primary purpose of the current article was to assess the effects of the most extensively tested genre of youth depression treatment: psychotherapy. In this article, we seek to answer the six questions listed below. What Is the Overall Effect of Psychotherapy on Youth Depression?The need to examine psychotherapy effects is underscored not only by evidence on the extent, impact, and sequelae of youth depression but also by recent debate over medication risks. Selective serotonin reuptake inhibitors (SSRIs) have become a widely used treatment for depressed youths (Safer, 1997; Treatment for Adolescents with Depression Study [TADS] Team, 2004;Weisz & Jensen, 1999), but concerns over possible risks, including suicidal ideation and suicide attempts (Vitiello & Swedo, 2004;Whittington...

Effects of psychotherapy for anxiety in children and adolescents: A meta-analytic review

“…Where the information was not provided separately by group we used the overall mean and standard deviation. In line with previous meta-analyses (e.g., Weisz, McCarty, & Valeri, 2006;Weisz, Weiss, Han, Granger, & Morton, 1995) we classified studies as child, adolescent, or mixed. Studies where participants were 13 and under were classified as 'child', studies where all participants were over 13 were classified as 'adolescent', and studies which included participants below and over 13 years were classified as 'mixed'.…”

Integrity of Evidence-Based Practice: Are Providers Modifying Practice Content or Practice Sequencing?

“…Additionally, since the design of the modular protocol allows providers to address a wider array of clinical concerns, it was hypothesized that youths who received the modular EBT would also utilize fewer subsequent services than those who received a traditional standardized EBT. Furthermore, because treatment gains tend to be STEPS SERVICE UTILIZATION 6 most potent immediately after completing an intervention and diminish over time (Weisz, McCarty, & Valeri, 2006), we anticipated differences in service use to be greater during youths' first year of study involvement-as clients may be more likely to seek additional (or adjunct) services if they are unsatisfied with their previous (or current) therapy-and increasingly subside during the second year-as their psychopathologies should have hopefully resolved, thus alleviating their need to access additional services.…”

Mood disorders in childhood and adolescence

“…Meta-analyses that investigated the efficacy of psychotherapy in the pediatric population (including 35 trials with children and adolescents 18 and 11 trials only with adolescents 19 ) suggested the efficacy of CBT, but with effect sizes around 0.3. The largest clinical trial for adolescents with depression performed to date (Treatment of Adolescent Depression Study, TADS) randomized 439 individuals to one of four options: CBT, fluoxetine, CBT + fluoxetine combination, or placebo.…”