Psychotherapy for depression among children and adolescents: a systematic review

OBJECTIVE: To examine the clinical benefit, the harm and the cost-effectiveness of psychotherapies in comparison with no treatment, waiting-list controls, attention-placebos, and treatment as usual in depressed youths. METHOD: Meta-analyses were undertaken by using data from all relevant randomized-controlled trials identified by a comprehensive literature search. The primary outcome was relative risk (RR) of response. RESULTS: We identified 27 studies containing 35 comparisons and 1,744 participants. At post-treatment, psychotherapy was significantly superior (RR = 1.39, 95% CI 1.18-1.65, P = 0.0001, number-needed to treat 4.3). There was an evidence of the existence of small study effects, including a publication bias (P < 0.001). The superiority of psychotherapy was no longer statistically significant (1.18 0.94-1.47, P = 0.15) at 6-month follow-up. None of the studies reported adverse effects or cost-effectiveness outcomes. CONCLUSION: Although the findings were biased by some small positive trials, psychotherapies appear to help depressed youths for the short term, but are no longer significantly favourable at 6-month follow-up.