Psychological Interventions in Primary Care for Depressed and Anxious Youth: A Systematic Review and Meta-Analysis

To characterize psychological interventions for depressed or anxious youth in primary care (PC), assess intervention effects and maintenance of treatment gains, and examine moderator and subgroup effects, we searched for randomized controlled trials (RCTs), quasi-experimental, and single-group design (SGD) studies evaluating psychological interventions delivered in PC to youth aged 2-21 years, published through October 2024. We extracted study, intervention, measure characteristics, and outcome data for measures of depression, anxiety, internalizing problems, suicidality, and functioning. We conducted meta-analyses using robust variance estimation to account for multiple outcomes per study and examined moderators including demographics, intervention characteristics, integration model, and target problem. Thirteen RCTs and 10 SGDs were included. Interventions had large pre-post effects (d = .77, 95% confidence interval [CI] [.52-1.03], k = 20), which strengthened at follow-up (d = 1.14, 95% CI [.65-1.63], k = 10) across RCTs and SGDs. However, intervention-control comparisons in RCTs revealed small, nonsignificant between-group effects. Moderator analyses were nonsignificant, but pre-post effects appeared smaller for studies with mostly racially/ethnically minoritized youth and for depression outcomes. Primary care-based psychological interventions showed meaningful benefits for depressed and anxious youth but did not outperform controls, highlighting the need to improve their effects for maximum public health impact.