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