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Efficacy and Acceptability of Cognitive Behavioral Therapy for Depression in Children: A Systematic Review and

Lining Yang¹, Xinyu Zhou¹, Chanjuan Zhou¹

¹Department of Neurology and Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Academic Pediatrics

|December 20, 2016

Insights

Cognitive Behavioral Therapy (CBT) shows benefits for childhood depression compared to no treatment. However, its effectiveness against waitlist or placebo controls is uncertain due to limited trial data and quality.

Area of Science:

Child and Adolescent Psychiatry
Clinical Psychology
Evidence-Based Medicine

Background:

Depression in children is a significant concern.
Few meta-analyses specifically examine Cognitive Behavioral Therapy (CBT) for pediatric depression.
Understanding CBT's efficacy in this population is crucial for clinical practice.

Purpose of the Study:

To systematically evaluate the effectiveness of CBT for depression in children (≤13 years old) through a meta-analysis.
To compare CBT's efficacy against various control conditions.
To assess treatment acceptability and remission rates.

Main Methods:

Systematic search of seven electronic databases (PubMed, Embase, CENTRAL, Web of Science, PsycINFO, CINAHL, LiLACS) up to September 2015.
Inclusion of randomized controlled trials comparing CBT with control conditions for childhood depression.
Meta-analysis of primary efficacy (symptom change) and secondary efficacy (remission), and acceptability (discontinuation rates).

Main Results:

Nine studies with 306 participants were analyzed.
CBT significantly outperformed control conditions in reducing depressive symptoms (SMD -0.41) and increasing remission rates (OR 2.16) at posttreatment.
Similar significant effects were observed at follow-up (SMD -0.34, OR 2.04).
CBT showed no significant difference in treatment discontinuation compared to controls (OR 0.69).
Subgroup analyses indicated CBT was effective only against nontreatment, not against waitlist or psychological placebo.

Conclusions:

CBT appears more beneficial than nontreatment for childhood depression.
The findings are limited by the small number of studies and low overall quality of the literature.
Further high-quality research is needed to confirm CBT's specific benefits in pediatric depression.

Read full analysis

Abstract

Background:

Few meta-analyses have focused on the effect of cognitive behavioral therapy (CBT) for depression in children.

Study Selection:

Randomized controlled trials comparing CBT with control conditions for depression in children (≤13 years old) were included.

Data Sources:

Seven electronic databases (PubMed, Embase, CENTRAL, Web of Science, PsycINFO, CINAHL, and LiLACS) were searched from inception to September 2015.

Data Extraction And Synthesis:

The primary efficacy was defined as mean change scores in depressive symptoms, and the second efficacy (remission) was a score below the threshold for a diagnosis of depression, both after treatment and at the end of follow-up. We also measured acceptability by the proportion of participants who discontinued treatment up to posttreatment.

Results:

Nine studies with 306 participants were selected for this analysis. At posttreatment, CBT was significantly more effective than control conditions in terms of primary efficacy (standardized mean difference, -0.41; 95% confidence interval [CI], -0.64 to -0.18) and secondary efficacy (odds ratio [OR], 2.16; 95% CI, 1.24 to 3.78). At follow-up, the results were consistent with those of efficacy outcomes at posttreatment, with a standardized mean difference of -0.34 and an OR of 2.04. CBT had no statistical more all-cause discontinuations than the control group (OR, 0.69; 95% CI, 0.26 to 1.82). However, subgroup analyses found that CBT was only significantly more effective than nontreatment, while it was not better than wait list or psychological placebo.

Conclusions:

CBT seems to be more beneficial in the treatment of depression in children than nontreatment; however, this finding is limited by the small size of the trials and low literature quality.

Keywords:

adolescent child depression meta-analysis psychotherapy

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