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Cited by 101Mental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

Systematic Review and Meta-analysis: Outcomes of Routine Specialist Mental Health Care for Young People With Depression and/or Anxiety

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Bear, Holly Alice, Edbrooke-Childs, Julian, Norton, Sam, Krause, Karolin Rose, Wolpert, Miranda·2020·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2019.12.002
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Abstract

Objective Depression and anxiety are the most prevalent mental health problems in youth, yet almost nothing is known about what outcomes are to be expected at the individual level following routine treatment. This paper sets out to address this gap by undertaking a systematic review of outcomes following treatment as usual (TAU) with a particular focus on individual-level outcomes. Method MEDLINE, Embase and PsycInfo were searched for articles published between 1980 and January 2019 that assessed TAU outcomes for youth depression and anxiety accessing specialist mental health care. Meta-analysis considered change at both group-level pre-post effect size (ES) and individual-level recovery, reliable change, and reliable recovery. Temporal analysis considered stability of primary and secondary outcomes over time. Subgroup analysis considered the moderating effect of informant; presenting problem; study design; study year; mean age of youth; use of medication; intervention dosage and type of treatment offered on outcomes. A protocol was preregistered on PROSPERO (CRD42017063914). Results Initial screening of 6,350 publications resulted in 38 that met the inclusion criteria, and that were subsequently included in meta-analyses. This resulted in a final full pooled sample of 11,739 young people (61% of whom were female, mean age 13.8 years). The pre-post ES (Hedges' g) at first/final outcome (13/26 weeks) was -0.74/-0.87. The individual-level change on measures of self-report was 38% reliable improvement, 44% no reliable change, and 6% reliable deterioration. Outcomes varied according to moderators, informant, problem type and dosage. Conclusion Poor data quantity and quality are limitations, but this is the first study that indicates likely rates of reliable improvement for those accessing TAU. We propose the need for improved reporting of both individual-level metrics and details of TAU to enable greater understanding of likely current outcomes from routine care for youths with depression and anxiety in order to allow the potential for further improvement of impact.

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  • Better training for primary care physicians to identify individuals at risk of suicide linked to moderate to severe depression in England was evaluated and found to be highly cost-effective.

    “One example is better training for primary care physicians to identify individuals at risk of suicide linked to moderate to severe depression in England. This was evaluated and found to be highly cost-effective. 658,659”

    From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [658]

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  1. [1]1. Bor W, Dean AJ, Najman J, Hayatbakhsh R. Are child and adolescent mental health problems increasing in the 21st century? A systematic review. Aust N Z J Psychiatry. 2014;48:606-616.
  2. [3]3. Hardeveld F, Spijker J, De Graaf R, Nolen W, Beekman A. Recurrence of major depressive disorder and its predictors in the general population: results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Psychol Med. 2013;43:39-48.
  3. [4]4. Clayborne ZM, Varin M, Colman I. Systematic review and meta-analysis: adolescent depression and long-term psychosocial outcomes. J Am Acad Child Adolesc Psychiatry. 2019;58:72-79.
  4. [5]5. Bruce SE, Yonkers KA, Otto MW, et al . In fl uence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry. 2005;162:1179-1187.
  5. [6]6. Fombonne E, Wostear G, Cooper V, Harrington R, Rutter M. The Maudsley longterm follow-up of child and adolescent depression: I. Psychiatric outcomes in adulthood. Br J Psychiatry. 2001;179:210-217.
  6. [8]8. Ollendick TH, Jarrett MA, Grills-Taquechel AE, Hovey LD, Wolff JC. Comorbidity as a predictor and moderator of treatment outcome in youth with anxiety, affective, attention de fi cit/hyperactivity disorder, and oppositional/conduct disorders. Clin Psychol Rev. 2008;28:1447-1471.
  7. [9]9. Fink E, Patalay P, Sharpe H, Holley S, Deighton J, Wolpert M. Mental health dif fi culties in early adolescence: a comparison of two cross-sectional studies in England from 2009 to 2014. J Adolesc Health. 2015;56:502-507.
  8. [11]11. David-Ferdon C, Kaslow NJ. Evidence-based psychosocial treatments for child and adolescent depression. J Clin Child Adolescent Psychol. 2008;37: 62-104.
  9. [12]12. Silverman WK, Hinshaw SP. The second special issue on evidence-based psychosocial treatments for children and adolescents: a 10-year update. J Clin Child Adolesc Psychol. 2008;37:1-7.
  10. [17]17. Spielmans GI, Gatlin ET, McFall JP. The ef fi cacy of evidence-based psychotherapies versus usual care for youths: controlling confounds in a meta-reanalysis. Psychother Res. 2010;20:234-246.
  11. [18]18. Howard KI, Moras K, Brill PL, Martinovich Z, Lutz W. Evaluation of psychotherapy: ef fi cacy, effectiveness, and patient progress. Am Psychol. 1996;51:1059.
  12. [19]19. Ogles BM, Lunnen KM, Bonesteel K. Clinical signi fi cance: history, application, and current practice. Clin Psychol Rev. 2001;21:421-446.
  13. [20]20. Jensen SA, Corralejo SM. Measurement issues: large effect sizes do not mean most people get better e clinical signi fi cance and the importance of individual results. Child Adolesc Ment Health. 2017;22:163-166.
  14. [21]21. Wolpert M. Commentary: why measuring clinical change at the individual level is challenging but crucial e commentary on Jensen and Corralejo (2017). Child Adolesc Ment Health. 2017;22:167-169.
  15. [22]22. Edbrooke-Childs J, Wolpert M, Zamperoni V, Napoleone E, Bear H. Evaluation of reliable improvement rates in depression and anxiety at the end of treatment in adolescents. BJPsych Open. 2018;4:250-255.
  16. [23]23. Wolpert M, G € orzig A, Deighton J, Fugard AJ, Newman R, Ford T. Comparison of indices of clinically meaningful change in child and adolescent mental health services: difference scores, reliable change, crossing clinical thresholds and ' added value ' e an exploration using parent rated scores on the SDQ. Child Adolesc Ment Health. 2015;20:94-101.
  17. [24]24. Smith AM, Jensen-Doss A. Youth psychotherapy outcomes in usual care and predictors of outcome group membership. Psychol Serv. 2017;14:66.
  18. [25]25. Murphy JM, Blais M, Baer L, et al . Measuring outcomes in outpatient child psychiatry: reliable improvement, deterioration, and clinically signi fi cant improvement. Clin Child Psychol Psychiatry. 2015;20:39-52.
  19. [26]26. Krause KR, Bear HA, Edbrooke-Childs J, Wolpert M. What outcomes count? A review of outcomes measured for adolescent depression between 2007 and 2017. J Am Acad Child Adolesc Psychiatry. 2019;58:61-71.
  20. [27]27. Kovacs M, Obrosky S, George C. The course of major depressive disorder from childhood to young adulthood: recovery and recurrence in a longitudinal observational study. J Affect Disord. 2016;203:374-381.
  21. [28]28. Nilsen TS, Handegård BH, Eisemann M, Kvernmo S. Predictors of rate of change for children and youth with emotional disorders: a naturalistic observational study. Child Adolesc Psychiatry Ment Health. 2016;10:11.
  22. [29]29. Gordon M, Antshel KM, Lewandowski L. Predictors of treatment outcome in a child and adolescent psychiatry clinic: a naturalistic exploration. Child Youth Services Rev. 2012;34:213-217.
  23. [30]30. Jackson DS, Keir SS, Sender M, Mueller CW. Reliable change and outcome trajectories across levels of care in a mental health system for youth. Admin Policy Ment Health Ment Health Services Res. 2017;44:141-154.
  24. [31]31. Brookman-Frazee L, Haine RA, Garland AF. Innovations: child and adolescent psychiatry: measuring outcomes of real-world youth psychotherapy: whom to ask and what to ask? Psychiatr Services. 2006;57:1373-1375.
  25. [33]33. Spielmans GI, Fl € uckiger C. Moderators in psychotherapy meta-analysis. Psychother Res. 2018;28:333-346.
  26. [34]34. Wolpert M, Rousmaniere T. Talking failure in therapy and beyond. Psychologist. 2017;30:40-43.
  27. [35]35. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Commun Health. 1998;52:377-384.
  28. [38]38. Hedges L, Olkin I. Statistical Models for Meta-analysis. New York: Academic Press; 1985.
  29. [41]41. Bachmann M, Bachmann CJ, John K, Heinzel-Gutenbrunner M, Remschmidt H, Mattejat F. The effectiveness of child and adolescent psychiatric treatments in a naturalistic outpatient setting. World Psychiatry. 2010;9:111-117.
  30. [42]42. Barrington J, Prior M, Richardson M, Allen K. Effectiveness of CBT versus standard treatment for childhood anxiety disorders in a community clinic setting. Behav Change. 2005;22:29-43.
  31. [43]43. Baruch G. Evaluating the outcome of a community-based psychoanalytic psychotherapy service for young people between 12 and 25 years old: work in progress. Psychoan Psychother. 1995;9:243-267.
  32. [44]44. Baruch G, Fearon P. The evaluation of mental health outcome at a community-based psychodynamic psychotherapy service for young people: a 12-month follow-up based on self-report data. Psychol Psychother. 2002;75:261-278.
  33. [46]46. Clarke G, Debar L, Lynch F, et al . A randomized effectiveness trial of brief cognitivebehavioral therapy for depressed adolescents receiving antidepressant medication. J Am Acad Child Adolesc Psychiatry. 2005;44:888-898.
  34. [47]47. Clarke G, DeBar LL, Pearson JA, et al . Cognitive behavioral therapy in primary care for youth declining antidepressants: a randomized trial. Pediatrics. 2016:e20151851.
  35. [48]48. Nemirovski Edlund J, Thor en A, Carlberg G. Outcome of psychodynamic child psychotherapy in routine practice. Eur J Psychother Counsel. 2014;16:228-244.
  36. [49]49. Edlund JN, Carlberg G. Psychodynamic psychotherapy with adolescents and young adults: outcome in routine practice. Clin Child Psychol Psychiatry. 2016;21:66-80.
  37. [50]50. Goldbeck L, Ellerkamp T. A randomized controlled trial of multimodal music therapy for children with anxiety disorders. J Music Ther. 2012;49:395-413.
  38. [52]52. J onsson H, Thastum M, Arendt K, Juul-Sørensen M. Group cognitive behavioural treatment of youth anxiety in community based clinical practice: clinical signi fi cance and benchmarking against ef fi cacy. J Anxiety Disord. 2015;35:9-18.
  39. [53]53. Kamin HS, McCarthy AE, Abel MR, Jellinek MS, Baer L, Murphy JM. Using a brief parent-report measure to track outcomes for children and teens with internalizing disorders. Child Psychiatry Hum Dev. 2015;46:851-862.
  40. [56]56. Muratori F, Picchi L, Bruni G, Patarnello M, Romagnoli G. A two-year follow-up of psychodynamic psychotherapy for internalizing disorders in children. J Am Acad Child Adolesc Psychiatry. 2003;42:331-339.
  41. [57]57. Nilsen TS, Handegård B-H, Eisemann M, Kvernmo S. Evaluating change in symptomatic and functional level of children and youth with emotional disorders: a naturalistic observation study. Eur Child Adolesc Psychiatry. 2015;24:1219-1231.
  42. [59]59. Sanford M, Boyle M, McCleary L, et al . A pilot study of adjunctive family psychoeducation in adolescent major depression: feasibility and treatment effect. J Am Acad Child Adolesc Psychiatry. 2006;45:386-395.
  43. [60]60. Southam-Gerow MA, Weisz JR, Chu BC, McLeod BD, Gordis EB, Connor-Smith JK. Does cognitive behavioral therapy for youth anxiety outperform usual care in community clinics? An initial effectiveness test. J Am Acad Child Adolesc Psychiatry. 2010; 49:1043-1052.
  44. [61]61. Walter D, Dachs L, Faber M, et al . Effectiveness of outpatient cognitive-behavioral therapy for adolescents under routine care conditions on behavioral and emotional problems rated by parents and patients: an observational study. Eur Child Adolesc Psychiatry. 2018;27:65-77.
  45. [62]62. Weisz JR, Southam-Gerow MA, Gordis EB, et al . Cognitive -behavioral therapy versus usual clinical care for youth depression: an initial test of transportability to community clinics and clinicians. J Consult Clin Psychol. 2009;77:383.
  46. [63]63. Weitkamp K, Daniels JK, Baumeister-Duru A, Wulf A, Romer G, Wiegand-Grefe S. Effectiveness trial of psychoanalytic psychotherapy for children and adolescents with severe anxiety symptoms in a naturalistic treatment setting. Br J Psychother. 2018;34: 300-318.
  47. [64]64. Young JF, Mufson L, Davies M. Impact of comorbid anxiety in an effectiveness study of interpersonal psychotherapy for depressed adolescents. J Am Acad Child Adolesc Psychiatry. 2006;45:904-912.
  48. [65]65. Gunlicks-Stoessel M, Mufson L. Early patterns of symptom change signal remission with interpersonal psychotherapy for depressed adolescents. Depress Anxiety. 2011;28: 525-531.
  49. [66]66. Gunlicks-Stoessel M, Mufson L, Jekal A, Turner JB. The impact of perceived interpersonal functioning on treatment for adolescent depression: IPT-A versus treatment as usual in school-based health clinics. J Consult Clin Psychol. 2010;78:260.
  50. [67]67. McGlinchey EL, Reyes-Portillo JA, Turner JB, Mufson L. Innovations in practice: the relationship between sleep disturbances, depression, and interpersonal functioning in treatment for adolescent depression. Child Adolesc Ment Health. 2017;22:96-99.
  51. [68]68. Reyes-Portillo JA, McGlinchey EL, Yanes-Lukin PK, Turner JB, Mufson L. Mediators of interpersonal psychotherapy for depressed adolescents on outcomes in Latinos: the role of peer and family interpersonal functioning. J Latina/o Psychol. 2017;5:248.
  52. [69]69. Asarnow JR, Jaycox LH, Duan N, et al . Effectiveness of a quality improvement intervention for adolescent depression in primary care clinics: a randomized controlled trial. JAMA. 2005;293:311-319.
  53. [70]70. Trask EV, Garland AF. Are children improving? Results from outcome measurement in a large mental health system. Admin Policy Ment Health Mental Health Services Res. 2012;39:210-220.
  54. [72]72. Porter S, McConnell T, McLaughlin K, et al . Music therapy for children and adolescents with behavioural and emotional problems: a randomised controlled trial. J Child Psychol Psychiatry. 2017;58:586-594.
  55. [74]74. Barwick M, Urajnik D, Sumner L, et al . Pro fi les and service utilization for children accessing a mental health walk-in clinic versus usual care. J Evid-Based Social Work. 2013;10:338-352.
  56. [75]75. Carter T, Guo B, Turner D, et al . Preferred intensity exercise for adolescents receiving treatment for depression: a pragmatic randomised controlled trial. BMC Psychiatry. 2015;15:247.
  57. [76]76. Deighton J, Argent R, De Francesco D, et al . Associations between evidence-based practice and mental health outcomes in child and adolescent mental health services. Clin Child Psychol Psychiatry. 2016;21:287-296.
  58. [77]77. Kenaley BLD, Williams NJ. A preliminary evaluation: demographic and clinical pro fi les and changes in functioning in children receiving psychosocial rehabilitation. Child Youth Services Rev. 2011;33:301-307.
  59. [79]79. Lundh A, Forsman M, Serlachius E, Lichtenstein P, Land en M. Outcomes of child psychiatric treatment. Acta Psychiatr Scand. 2013;128:34-44.
  60. [80]80. O ' Brien F, Olden N, Migone M, et al . Group cognitive behavioural therapy for children with anxiety disorder -an evaluation of the ' Friends for Youth ' programme. Irish J Psychol Medicine. 2007;24:5-12.
  61. [81]81. Sharma P, Mehta M, Sagar R. Ef fi cacy of transdiagnostic cognitive-behavioral group therapy for anxiety disorders and headache in adolescents. J Anxiety Disord. 2017; 46:78-84.
  62. [82]82. Shirk SR, DePrince AP, Crisostomo PS, Labus J. Cognitive behavioral therapy for depressed adolescents exposed to interpersonal trauma: an initial effectiveness trial. Psychotherapy. 2014;51:167.
  63. [83]83. Strandholm T, Karlsson L, Kiviruusu O, Pelkonen M, Marttunen M. Treatment characteristics and outcome of depression among depressed adolescent outpatients with and without comorbid axis II disorders. J Personal Disord. 2014;28:853-863.
  64. [84]84. Sultan MA, Courtney DB. Adjunctive trazodone and depression outcome in adolescents treated with serotonin re-uptake inhibitors. J Can Acad Child Adolesc Psychiatry. 2017;26:233-240.
  65. [85]85. Weersing VR, Weisz JR. Community clinic treatment of depressed youth: benchmarking usual care against CBT clinical trials. J Consult Clin Psychol. 2002;70:299.
  66. [86]86. Weersing VR, Iyengar S, Kolko DJ, Birmaher B, Brent DA. Effectiveness of cognitivebehavioral therapy for adolescent depression: a benchmarking investigation. Behav Ther. 2006;37:36-48.
  67. [87]87. Wiggins A, Oakley Browne M, Bearsley-Smith C, Villanueva E. Depressive disorders among adolescents managed in a child and adolescent mental health service. Australasian Psychiatry. 2010;18:134-141.
  68. [88]88. Burcusa SL, Iacono WG. Risk for recurrence in depression. Clin Psychol Rev. 2007;27: 959-985.
  69. [90]90. Neufeld SA, Dunn VJ, Jones PB, Croudace TJ, Goodyer IM. Reduction in adolescent depression after contact with mental health services: a longitudinal cohort study in the UK. Lancet Psychiatry. 2017;4:120-127.
  70. [92]92. Edbrooke-Childs J, Jacob J, Law D, Deighton J, Wolpert M. Interpreting standardized and idiographic outcome measures in CAMHS: what does change mean and how does it relate to functioning and experience? Child Adolesc Ment Health. 2015;20:142-148.
  71. [93]93. Clark DM, Canvin L, Green J, Layard R, Pilling S, Janecka M. Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data. Lancet. 2018;391:679-686.
  72. [94]94. Cannon JA, Warren JS, Nelson PL, Burlingame GM. Change trajectories for the Youth Outcome Questionnaire Self-Report: identifying youth at risk for treatment failure. J Clin Child Adolesc Psychol. 2010;39:289-301.
  73. [95]95. Warren JS, Nelson PL, Mondragon SA, Baldwin SA, Burlingame GM. Youth psychotherapy change trajectories and outcomes in usual care: community mental health versus managed care settings. J Consult Clin Psychol. 2010;78:144.
  74. [96]96. Napoleone E, Evans C, Patalay P, Edbrooke-Childs J, Wolpert M. Trajectories of change of youth depressive symptoms in routine care: shape, predictors, and service-use implications. Eur Child Adolesc Psychiatry. 2019;28:1527-1536.
  75. [97]97. Peselow ED, Karamians R, Lord M, Tobia G, IsHak WW. The discrepancy between patients and informants on clinician-rated measures in major depressive disorder: implications for clinical trials and clinical practice. Int Clin Psychopharmacol. 2014;29: 111-115.
  76. [98]98. Mulley A, Coulter A, Wolpert M, Richards T, Abbasi K. New approaches to measurement and management for high integrity health systems. BMJ. 2017;356: j1401.
  77. [100]100. Cristea IA, Stefan S, Karyotaki E, David D, Hollon SD, Cuijpers P. The effects of cognitive behavioral therapy are not systematically falling: a revision of Johnsen and Friborg (2015). Psychol Bull. 2017;143:326-340.
  78. [101]101. Patalay P, Fitzsimons E. Correlates of mental illness and wellbeing in children: are they the same? Results from the UK Millennium Cohort Study. J Am Acad Child Adolesc Psychiatry. 2016;55:771-783.

Cited by

Sorted by citations

Authors
Bear, H. A., Edbrooke-Childs, J., Norton, S., Krause, K. R., & Wolpert, M.
Affiliations
  • Anna Freud Centre (GB)
  • Guy's Hospital (GB)
Corresponding author
Bear, Holly Alice
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2020-07
Volume
59
Issue
7
Pages
810-841
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2019.12.002
OpenAlex
W2997931242
Cited by
101
References
22
Citations by year
2026: 9 · 2025: 9 · 2024: 18 · 2023: 17 · 2022: 19 · 2021: 19 · 2020: 10
FWCI
1.85
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
adolescent depression, youth anxiety, specialist mental health care, usual care, reliable change, informant effects, treatment dosage, adolescent mental health
MeSH terms
Adolescent, Anxiety, Anxiety Disorders, Depression, Female, Humans, Mental Health, Treatment Outcome

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