Problem-solving interventions and depression among adolescents and young adults: A systematic review of the effectiveness of problem-solving interventions in preventing or treating depression among 13-25 year olds

Abstract

Background: Problem-solving (PS) has been identified as a common element in multiple evidence-based treatments for the prevention and treatment of depression. We undertook a systematic review of evidence for the effectiveness and implementation of PS for the prevention and treatment of depression among 13-25 year olds.Methods: We searched electronic databases (PsycInfo, Medline, and Cochrane Library) for studies published between 2000 and 2020 described by authors as a PS intervention or including PS approaches to treat or prevent depression in 13-25 year olds. Eighteen out of 902 effectiveness studies and 1 out of 480 implementation studies met inclusion criteria. Results: The interventions studied were heterogeneous in population, intervention, modality, comparison condition, study design, and outcome. Eight focused purely on PS; eight used PS as part of a wider intervention. Six studies found positive effects in reducing depression, and two in reducing suicidality. Seven measured effects on PS skills. There was little evidence of change in PS skills, about PS skills as mediator or moderator of effects on depression, or about the fit, feasibility, or acceptability of PS interventions. Discussion: There is mixed evidence about the effectiveness of PS as treatment and prevention of depression among AYAs although our findings suggest it can work in a wide range of contexts and forms. Possible explanations for limited effectiveness are: not all studies included populations where depression was known to be present; variability in quality, dosage and fidelity monitoring; small samples size and short follow-up periods.