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Cited by 323Psychotherapy Techniques and ApplicationsChild and Adolescent Psychosocial and Emotional DevelopmentChild Therapy and Development

Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: a systematic review and network meta-analysis

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Zhou, Xinyu, Hetrick, Sarah E., Cuijpers, Pim, Qin, Bin, Barth, Jürgen, Whittington, Craig J., Cohen, David, Del Giovane, Cinzia +5 more·2015·World Psychiatry
DOI 10.1002/wps.20217PMC PMC4471978
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Abstract

Previous meta-analyses of psychotherapies for child and adolescent depression were limited because of the small number of trials with direct comparisons between two treatments. A network meta-analysis, a novel approach that integrates direct and indirect evidence from randomized controlled studies, was undertaken to investigate the comparative efficacy and acceptability of psychotherapies for depression in children and adolescents. Systematic searches resulted in 52 studies (total N=3805) of nine psychotherapies and four control conditions. We assessed the efficacy at post-treatment and at follow-up, as well as the acceptability (all-cause discontinuation) of psychotherapies and control conditions. At post-treatment, only interpersonal therapy (IPT) and cognitive-behavioral therapy (CBT) were significantly more effective than most control conditions (standardized mean differences, SMDs ranged from -0.47 to -0.96). Also, IPT and CBT were more beneficial than play therapy. Only psychodynamic therapy and play therapy were not significantly superior to waitlist. At follow-up, IPT and CBT were significantly more effective than most control conditions (SMDs ranged from -0.26 to -1.05), although only IPT retained this superiority at both short-term and long-term follow-up. In addition, IPT and CBT were more beneficial than problem-solving therapy. Waitlist was significantly inferior to other control conditions. With regard to acceptability, IPT and problem-solving therapy had significantly fewer all-cause discontinuations than cognitive therapy and CBT (ORs ranged from 0.06 to 0.33). These data suggest that IPT and CBT should be considered as the best available psychotherapies for depression in children and adolescents. However, several alternative psychotherapies are understudied in this age group. Waitlist may inflate the effect of psychotherapies, so that psychological placebo or treatment-as-usual may be preferable as a control condition in psychotherapy trials.

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  • Cognitive behavioral therapy (CBT) is effective for treating mild to moderate symptoms of depression and anxiety in children and adolescents.

    “The effectiveness of cognitive behavioral therapy (CBT) for treating mild to moderate symptoms of depression and anxiety in children and adolescents is well established (e.g. Zhou et al., 2015; Zhou et al., 2019).”

    From Involving patients' perspective in the development of an internet- and mobile-based CBT intervention for adolescents with chronic medical conditions: Findings from a qualitative study (2021) · cites this paper as Zhou et al., 2015

    The Results report that CBT was significantly more effective than several comparators for depression in children and adolescents at short-term follow-up. The paper notes a recommendation for psychotherapy for mild-to-moderate depression, but does not establish CBT's efficacy specifically for that severity group or for anxiety symptoms. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Cognitive behavioral therapy (CBT) is generally regarded as the treatment of choice for depression and anxiety in children and adolescents.

    “Cognitive behavioral therapy (CBT) is generally regarded as the treatment of choice for depression and anxiety in children and adolescents.11,16”

    From Comparative efficacy and acceptability of bibliotherapy for depression and anxiety disorders in children and adolescents: a meta-analysis of randomized clinical trials (2018) · cites this paper as [16]

    The Discussion conclusion (page unavailable in our copy) recommends CBT and interpersonal psychotherapy as initial psychological treatments for depression in children and adolescents. The paper does not establish CBT as the sole treatment of choice, and it does not assess treatment of anxiety. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • CBT is most commonly provided face-to-face by a therapist and has demonstrated efficacy on children and adolescents with depression and/or anxiety problems.

    “CBT is most commonly provided face-to-face by a therapist and has demonstrated efficacy on children and adolescents with depression and (or) anxiety problems.11,16”

    From Comparative efficacy and acceptability of bibliotherapy for depression and anxiety disorders in children and adolescents: a meta-analysis of randomized clinical trials (2018) · cites this paper as [16]

    The Discussion (page not supplied) reports that CBT was significantly more beneficial than most control conditions for children and adolescents with depression. The cited paper does not establish that CBT is most commonly delivered face-to-face by a therapist or demonstrate its efficacy for anxiety problems. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • A protocol emphasizing cognitive changes is more difficult for young people to engage in, especially children.

    “A possible interpretation is that a protocol emphasizing on cognitive changes is more difficult for young people to engage in, especially children.16”

    From Comparative efficacy and acceptability of bibliotherapy for depression and anxiety disorders in children and adolescents: a meta-analysis of randomized clinical trials (2018) · cites this paper as [16]

    The Discussion (page not specified) offers the same possible interpretation: protocols emphasizing cognitive changes may be harder for young people to engage in. It does not say this is especially true for children or compare children with adolescents on engagement. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • The development of self-identity plays a crucial role in reducing depressive symptoms and enhancing psychological resilience.

    “The development of self-identity plays a crucial role in reducing depressive symptoms and enhancing psychological resilience (43, 44).”

    From Recent developments in bibliotherapy for adolescent depression (2025) · cites this paper as [43]

    The Outcome measures and Results sections assess psychotherapies by changes in depressive symptoms, not by self-identity development or psychological resilience. Searches for self-identity, identity development, and resilience found no passage linking self-identity to either claimed outcome. Page numbers were not available in the indexed passages. (LLM, conf=0.76)

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Cites

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Research works printed but not linked: 8

  1. Ackerson J, Scogin F, McKendree-Smith N et al. Cognitive bib- liotherapy for mild and moderate adolescent depressive symp- tomatology. J Consult Clin Psychol 1998;66:685-90.
  2. Curtis SE. Cognitive-behavioral treatment of adolescent depres- sion. Doctoral dissertation, Utah State University, Logan, 1992.
  3. Dana E. A cognitive-behavioral intervention for conduct disor- dered and concurrently conduct disordered and depressed chil- dren. Doctoral dissertation, Adelphi University School of Social Work, Garden City, New York, 1998.
  4. Fischer SA. Development and evaluation of group cognitive- behavioral therapy for depressed and suicidal adolescents in juve- nile detention. Doctoral dissertation, University of Alabama, Tusca- loosa, 1995.
  5. Hickman KA. Effects of social skills training on depressed chil- dren attending a behavioral day treatment program. Doctoral dissertation, Hofstra University, Hempstead, New York, 1994.
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  7. Moldenhauer Z. Adolescent depression: a primary care pilot intervention study. Doctoral dissertation, University of Roches- ter, New York, 2004.
  8. Phillips J. An evaluation of school-based cognitive-behavioral social skills training groups with adolescents at risk for depres- sion. Doctoral dissertation, University of Texas at Arlington, Arlington, 2004.

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Authors
Zhou, X., Hetrick, S. E., Cuijpers, P., Qin, B., Barth, J., Whittington, C. J., Cohen, D., Del Giovane, C., Liu, Y., Michael, K. D., Zhang, Y., Weisz, J. R., & Xie, P.
Affiliations
  • The Affiliated Yongchuan Hospital of Chongqing Medical University (CN)
  • The University of Melbourne (AU)
  • Vrije Universiteit Amsterdam (NL)
  • University of Zurich (CH)
  • University College London (GB)
  • Pitié-Salpêtrière Hospital (FR)
  • Department of Diagnostic, Clinical and Public Health Medicine; University of Modena and Reggio Emilia; Modena Italy
  • Appalachian State University (US)
  • Harvard University (US)
ORCID
Venue
World Psychiatry
Publisher
Wiley
Published
2015-06
Volume
14
Issue
2
Pages
207-222
ISSN
1723-8617 (ISSN-L)
DOI
10.1002/wps.20217
PMC
PMC4471978
OpenAlex
W1869247044
Cited by
322
References
104
Citations by year
2026: 16 · 2025: 16 · 2024: 31 · 2023: 19 · 2022: 31 · 2021: 52 · 2020: 45 · 2019: 32 · 2018: 34 · 2017: 20 · 2016: 22 · 2015: 4
FWCI
3.83
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 92 d)
Locations
  • World Psychiatry (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • VU Research Portal (publishedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
  • University of Bristol
  • Adnan Menderes Üniversitesi
  • National Key Research and Development Program of China (2009CB918300)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Clinical Psychology › Child Therapy and Development
Keywords
child and adolescent depression, psychotherapy efficacy, interpersonal psychotherapy, cognitive behavioral therapy, play therapy, psychodynamic psychotherapy, problem-solving therapy, treatment discontinuation, usual care

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