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Review: Psychotherapy for adolescents with depression: initial but no sustainable benefits
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Norio Watanabe

Correspondence to: Norio Watanabe, Department of Psychiatry and Cognitive Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku Nagoya 467-8601, Japan; norio@med.nagoya-cu.ac.jp

QUESTION

Question:

Is psychotherapy an effective way to treat children and adolescents with depression?

Outcomes:

Risk of response, defined as score below the threshold for diagnosis of depression on whichever scale the study used—“operationalized criteria” or “a validated depression severity measure”. Secondary outcomes were cost and safety of treatment.

METHODS

Design:

Systematic review with meta-analysis.

Data sources:

Cochrane CENTRAL, MEDLINE, CINAHL, PsycINFO, EMBASE, PSYNDEX, LILACS, conference proceedings and hand searches of journals; performed by searching the Cochrane Collaboration Depression, Anxiety and Neurosis Registers on 17 December 2004. Additional supplementary search of CENTRAL, MEDLINE, PsycINFO and EMBASE was carried out, and from the selected papers, reference lists were examined and lead authors contacted for further data on other trials.

Study selection and analysis:

Individual or cluster randomised controlled trials of any psychotherapy (PT) versus no treatment, attention-placebo, waiting-list control, or treatment as usual, in adolescents (aged 6–18 years) with depression or dysthymia. Attention-placebo was defined …

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Supplementary materials

  • web only references 11/2/49

    Subgroup analyses of specific types of psychotherapy models showed significant post-treatment benefit of PT over control for BT (RR response: 6.76, 95% CI 1.45 to 31.40; p=0.01), IPT (RR response: 1.68, 95% CI 1.08 to 2.63; p=0.02), and CBT (RR response: 1.38, 95% CI 1.14 to 1.66; p=0.0009). At 1�6 month follow-up and 6�12 month follow-ups, there were no differences in response between different models of PT and control conditions. Subgroup analyses by control condition revealed significant post-treatment benefit of PT over attention-placebo (RR response: 1.48, 95% CI 1.12 to 1.96; p=0.006). This benefit was not evident at 1�6 month or 6�12 month follow-ups. There was a significant post-treatment benefit of PT over waiting list control (RR response: 2.00, 95% CI 1.34 to 2.98; p=0.0006), and also at 1�6 months (RR response: 1.98, 95% CI 1.27 to 3.07). There was no difference in response between PT (combined with TAU) and TAU alone, or PT and no treatment at any time point. PT improved post-treatment response in adolescents (RR response: 1.35, 95% CI 1.10 to 1.66; p=0.004), but not among children (6�12 years). PT improved response regardless of depression severity (mild to moderate or moderate to severe).
    However, the analyses did not correct for the multiple subgroup analyses. This may have led to false-positive conclusions.
    Most of the trials examined adolescents aged 12�18 years (81%), and were in people with mild to moderate depression (79%); 64% of participants were female. Follow-up ranged from between 1�6 months (14 studies) and 6�12 months (8 studies). Trials varied in methodological quality and diagnostic criteria used for diagnosing depression. Heterogeneity between studies was significant (p=0.04) and publication bias was significant (p <_0.001. _--="_--" end="end" desc="desc" dc1="dc1">

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