Comparative efficacy and acceptability of bibliotherapy for depression and anxiety disorders in children and adolescents: a meta-analysis of randomized clinical trials
Open accessAbstract
BACKGROUND: Depression and anxiety are the most common mental disorders in children and adolescents. Bibliotherapy is a treatment using written materials for mental health problems. Its main advantages are ease of use, low cost, low staffing demands, and greater privacy. Yet few meta-analyses have focused on the effect of bibliotherapy on depression and anxiety disorders in children and adolescents. METHODS: We included randomized controlled trials comparing bibliotherapy with control conditions for depression and anxiety in children and adolescents (aged ≤18 years). Five electronic databases (PubMed, Embase, Cochrane, Web of Science, and PsycINFO) were searched from inception to January 2017. Efficacy was defined as mean change scores in depression and anxiety symptoms. Acceptability was defined as the proportion of participants who discontinued the treatment. Random effects model was used. An intention-to-treat analysis was conducted. RESULTS: Eight studies with 979 participants were selected. At posttreatment, bibliotherapy was significantly more effective than the control conditions in reducing the symptoms of depression or anxiety (standardized mean difference, -0.52; 95% confidence interval [CI], -0.89 to -0.15). Bibliotherapy did not have statistically significantly more all-cause discontinuations than controls (risk ratios, 1.66; 95% CI, 0.93 to 2.95). We also performed subgroup analyses for efficacy outcomes in different categories (types of disorder, mean age, control conditions, and parental involvement) of studies and found that bibliotherapy has been more effective in depressive adolescents. LIMITATIONS: Limited studies were eligible in this review and hence there was potential publication bias. CONCLUSION: According to the findings in this review, bibliotherapy may be more beneficial in treating depression in adolescents, but shows less robust effects for anxiety in children. Further well-defined clinical studies should be performed to confirm these outcomes.
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Written from the paper’s full text.
TL;DR
This meta-analysis of eight randomized trials (979 children/adolescents) found bibliotherapy significantly reduced depression or anxiety symptoms versus control at posttreatment, with a pooled SMD of −0.52 (95% CI −0.89 to −0.15). Effects were stronger for depressive adolescents than for anxious children, and the authors conclude bibliotherapy may be effective and acceptable for adolescent depression but less robust for childhood anxiety.
Key findings
- Bibliotherapy was significantly more effective than control conditions at posttreatment for depression or anxiety symptoms: SMD −0.52 (95% CI −0.89 to −0.15; p=0.006), with high heterogeneity (I²=84%, p<0.00001).
- All-cause discontinuation did not differ statistically between bibliotherapy and controls: RR 1.66 (95% CI 0.93 to 2.95; p=0.09), with moderate heterogeneity (I²=40%, p=0.14).
- Subgroup analyses found bibliotherapy was significantly more beneficial for depressive patients (SMD −0.78, 95% CI −1.42 to −0.14; p=0.02) and adolescents (SMD −0.78, 95% CI −1.42 to −0.14; p=0.02), but less robust for anxiety patients (SMD −0.36, 95% CI −0.88 to 0.17; p=0.18) and children (SMD −0.36, 95% CI −0.88 to 0.17; p=0.18).
- Sensitivity analysis excluding small studies (≤50 patients) changed the effect to SMD −0.13 (95% CI −0.36 to 0.11; p=0.30), and the Egger test indicated publication bias (t=−4.89, p=0.0014).
Methods
- Systematic review and pairwise random-effects meta-analysis of randomized controlled trials comparing bibliotherapy alone with control conditions (wait-list, non-treatment, treatment as usual, or psychological placebo) for children and adolescents with depression and/or anxiety.
- Five electronic databases (PubMed, Embase, Cochrane, Web of Science, PsycINFO) were searched from inception to January 2017; eight studies with 979 participants met inclusion criteria.
- Efficacy was mean change in depression/anxiety symptoms; acceptability was all-cause discontinuation; analyses used intention-to-treat, subgroup analyses by disorder type, mean age, control condition, and parental involvement, plus sensitivity analysis excluding small samples.
Limitations
- The paper states that limited studies were eligible and there was potential publication bias; it also notes significant heterogeneity from broad inclusion criteria, low overall study quality, lack of follow-up in six of eight studies, and no data on adverse effects or cost-effectiveness.
- The paper states that included studies covered only adolescents with depressive symptoms or children with anxiety symptoms, so further research is needed on adolescents with anxiety and children with depression.
- Evident from the text: the sensitivity analysis showed the efficacy result was not robust after excluding small studies, and the authors caution that small trials may exaggerate treatment effects; publication bias was also indicated by funnel plot asymmetry and the Egger test.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
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Cites
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Claims the paper makes
14 of 54 cited sources checked · 5 supported · 0 flagged · accuracy not yet measured
- Premisecitation
Bibliotherapy based on psychological treatments of proven efficacy may provide a more accessible source of psychological help.
“Bibliotherapy based on psychological treatments of proven efficacy may provide a more accessible source of psychological help.24,25”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [24] Fanner D Urquhart C Bibliotherapy for mental health service users Part 1: a systematic review Health Info Libr J 2008 25 4 237 252 19076670 source
- cites [25] Mendel M Harris J Carson N Bringing bibliotherapy for children to clinical practice J Am Acad Child Adolesc Psychiatry 2016 55 7 535 537 27343878 source
- Premisecitation
In psychotherapy trials, acceptability may be more connected with treatment efficacy than tolerability.
“In fact, in psychotherapy trials, acceptability may be more connected with treatment efficacy than tolerability, because few adverse effects are reported in these psychotherapy trials; in addition, acceptability may also be influenced by the views and concerns of the youths and/or their parents.36”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [36] Zhang Y Zhou X James AC Comparative efficacy and acceptability of psychotherapies for acute anxiety disorders in children and adolescents: study protocol for a network meta-analysis BMJ Open 2015 5 10 e008572 PMC4606384 26443658 source
- Findingown data
Bibliotherapy did not have statistically significantly more all-cause discontinuations than controls (RR 1.66, 95% CI 0.93 to 2.95).
“Bibliotherapy did not have statistically significantly more all-cause discontinuations than controls (risk ratios, 1.66; 95% CI, 0.93 to 2.95).”
- Also stated in: § Acceptability outcomes · plain
“In terms of the acceptability outcomes, there was no statistical difference between the bibliotherapy intervention group and control group at posttreatment (Figure 3).”
Quote in the paperSubstantial claim - Also stated in: § Acceptability outcomes · plain
- Findingown data
At posttreatment, bibliotherapy was significantly more effective than control conditions in reducing symptoms of depression or anxiety (SMD -0.52, 95% CI -0.89 to -0.15).
“At posttreatment, bibliotherapy was significantly more effective than the control conditions in reducing the symptoms of depression or anxiety (standardized mean difference, −0.52; 95% confidence interval [CI], −0.89 to −0.15).”
- Also stated in: § Efficacy outcomes · plain
“The overall pooled effect size indicated a significant advantage over bibliotherapy at posttreatment, with an SMD of −0.52 (95% CI, −0.89 to −0.15; p=0.006).”
Quote in the paperSubstantial claim - Also stated in: § Efficacy outcomes · plain
- Findingown data
In subgroup analyses, bibliotherapy was more effective in depressive adolescents.
“We also performed subgroup analyses for efficacy outcomes in different categories (types of disorder, mean age, control conditions, and parental involvement) of studies and found that bibliotherapy has been more effective in depressive adolescents.”
Quote in the paperNot a substantial claim
- Findingown data
Bibliotherapy does not result in statistically significantly more all-cause discontinuation than control conditions.
“For acceptability outcomes, we found that bibliotherapy had no statistical more all-cause discontinuation than controls.”
- Also stated in: § Discussion · plain
“For acceptability outcomes, we found that bibliotherapy had no statistical more all-cause discontinuations than controls.”
Quote in the paperSubstantial claim - Also stated in: § Discussion · plain
- Findingown data
Bibliotherapy was significantly more beneficial than control in studies including adolescent patients (SMD -0.78, 95% CI -1.42 to -0.14; p=0.02).
“Furthermore, bibliotherapy was significantly more beneficial than control in studies including adolescent patients (SMD =−0.78, 95% CI −1.42 to −0.14; p=0.02) and showed less robust effects in studies including children (SMD =−0.36, 95% CI −0.88 to 0.17; p=0.18).”
Quote in the paperSubstantial claim - Findingnone given
The all-cause discontinuation of bibliotherapy groups remained high.
“However, the all-cause discontinuation of bibliotherapy groups remained high.”
Quote in the paperSubstantial claim - Findingown data
In studies with parental involvement, bibliotherapy failed to show a higher effect size than control conditions (SMD -0.20, 95% CI -0.74 to 0.34; p=0.47).
“In studies with parental involvement, bibliotherapy failed to show a higher effect size than control conditions (SMD =−0.20, 95% CI −0.74 to 0.34; p=0.47).”
Quote in the paperSubstantial claim - Findingown data
Bibliotherapy showed less robust effects in studies including children (SMD -0.36, 95% CI -0.88 to 0.17; p=0.18).
“Furthermore, bibliotherapy was significantly more beneficial than control in studies including adolescent patients (SMD =−0.78, 95% CI −1.42 to −0.14; p=0.02) and showed less robust effects in studies including children (SMD =−0.36, 95% CI −0.88 to 0.17; p=0.18).”
Quote in the paperSubstantial claim - Findingown data
In a sensitivity analysis excluding studies with small sample sizes (≤50 patients), the effect size changed substantively (SMD -0.13, 95% CI -0.36 to 0.11; p=0.30).
“We performed a sensitivity analysis by excluding the studies that involved small sample sizes (≤50 patients). This led to a substantive change in the effect size (SMD =−0.13, 95% CI −0.36 to 0.11; p=0.30; Figure S3).”
Quote in the paperNot a substantial claim - Findingown data
The efficacy outcomes were not robust in sensitivity analysis.
“Since the sensitivity analysis suggested that the efficacy outcomes were not robust and there was potential bias due to publication, there is a need for further research.”
Quote in the paperSubstantial claim - Findingown data
The funnel plot indicated a certain publication bias.
“Third, the funnel plot indicated a certain publication bias, so caution is required in interpreting our findings; we could not include data on adverse effects or cost-effectiveness because of lacking data, although these variables are important for clinical decisions.”
Quote in the paperNot a substantial claim - Findingown data
There was moderate heterogeneity in acceptability outcomes (I2=40%, p=0.14).
“The RR value was 1.66 (95% CI, 0.93 to 2.95; p=0.09) with moderate heterogeneity (I2=40%, p=0.14).”
Quote in the paperNot a substantial claim - Findingown data
In studies without parental involvement, bibliotherapy was significantly more beneficial than control conditions (SMD -0.76, 95% CI -1.29 to -0.15; p=0.005).
“However, in studies without parental involvement, bibliotherapy was significantly more beneficial than control conditions (SMD =−0.76, 95% CI −1.29 to −0.15; p=0.005).”
Quote in the paperSubstantial claim - Findingown data
Bibliotherapy was not significantly more effective in studies with parental involvement.
“The subgroup analysis of parental involvement showed that bibliotherapy was not significantly more effective in studies with parental involvement.”
Quote in the paperNot a substantial claim - Findingown data
Bibliotherapy was significantly more beneficial than control in studies including depressive patients (SMD -0.78, 95% CI -1.42 to -0.14; p=0.02).
“Bibliotherapy was significantly more beneficial than control in studies including depressive patients (SMD =−0.78, 95% CI −1.42 to −0.14; p=0.02) and showed less robust effects in studies including anxiety patients (SMD =−0.36, 95% CI −0.88 to 0.17; p=0.18).”
Quote in the paperSubstantial claim - Findingown data
Heterogeneity in effect sizes for efficacy was high (I2=84%, p<0.00001).
“Heterogeneity in effect sizes was high (I2=84%, p<0.00001).”
Quote in the paperNot a substantial claim - Findingown data
Some participants stopped bibliotherapy when children resisted being involved or learning the skills was difficult.
“First, some participants stopped when children resisted being involved or learning the skills was difficult.”
Quote in the paperSubstantial claim - Findingown data
Compared with control conditions, bibliotherapy is an effective treatment for reducing depressive symptoms in adolescents.
“Our meta-analysis found that, compared with control conditions, bibliotherapy is an effective treatment for reducing depressive symptoms in adolescents.”
Quote in the paperSubstantial claim - Findingown data
Bibliotherapy showed less robust effects for children with anxiety.
“We found that bibliotherapy showed less robust effects for children with anxiety.”
Quote in the paperSubstantial claim - Findingown data
There was potential bias due to publication.
“there was potential bias due to publication”
- Also stated in: § Discussion · hedged
“The funnel plot indicated a certain publication bias”
Quote in the paperSubstantial claim - Also stated in: § Discussion · hedged
- Findingown data
There was no significant difference between studies including different disorder conditions (p=0.31).
“We failed to find a significant difference between studies including different disorder conditions (p=0.31).”
Quote in the paperNot a substantial claim - Findingown data
Bibliotherapy was more efficacious than wait-list control (SMD -0.61, 95% CI -1.21 to -0.02; p=0.04).
“More specifically, we found that bibliotherapy was more efficacious than WL (SMD =−0.61, 95% CI −1.21 to −0.02; p=0.04).”
Quote in the paperSubstantial claim - Findingown data
Our included studies with parental involvement are all for anxious children.
“However, our included studies with parental involvement are all for anxious children.”
Quote in the paperSubstantial claim - Findingown data
The effect size was significantly associated with the control conditions (p<0.01).
“We found that the effect size was significantly associated with the control conditions (p<0.01).”
Quote in the paperSubstantial claim - Findingown data
We did not observe a robust treatment effect by different patient characteristics and intervention settings in the other subgroup analyses.
“In the other subgroup analyses, we did not observe a robust treatment effect by different patient characteristics and intervention settings.”
Quote in the paperSubstantial claim - Findingown data
Bibliotherapy was not better than PBO.
“Among the three control conditions, bibliotherapy was significantly more beneficial than WL and NT, whereas it was not better than PBO.”
Quote in the paperSubstantial claim - Findingown data
Bibliotherapy showed less robust effects in studies including anxiety patients (SMD -0.36, 95% CI -0.88 to 0.17; p=0.18).
“Bibliotherapy was significantly more beneficial than control in studies including depressive patients (SMD =−0.78, 95% CI −1.42 to −0.14; p=0.02) and showed less robust effects in studies including anxiety patients (SMD =−0.36, 95% CI −0.88 to 0.17; p=0.18).”
Quote in the paperSubstantial claim - Findingown data
Some participants did not start the bibliotherapy program because of difficulty finding time.
“Second, some participants did not start the program because of difficulty finding “time.””
Quote in the paperNot a substantial claim - Findingown data
Bibliotherapy was not significantly more effective in trials with large samples.
“The sensitivity analysis indicated that bibliotherapy was not significantly more effective in trials with large samples; however, a possible explanation is that trials with smaller sample sizes might result in an exaggerated treatment effect.53”
Quote in the paperNot a substantial claim - Interpretationreasoning
Limitations in availability and accessibility of CBT have led to an increased focus on self-help approaches to widen access to mental health interventions.
“These limitations have led to an increased focus on self-help approaches to widen the access to mental health interventions.”
Quote in the paperSubstantial claim - Study design and conductnone given
Limited studies were eligible in this review.
“Limited studies were eligible in this review and hence there was potential publication bias.”
Quote in the paperSubstantial claim - Study design and conductown data
There was potential publication bias for the efficacy outcome, indicated by funnel plot asymmetry and Egger test (t=-4.89, p=0.0014).
“Limited studies were eligible in this review and hence there was potential publication bias.”
- Also stated in: § Quality assessment and publication bias · hedged
“For the efficacy outcome, funnel plot asymmetry was seen, showing a potential publication bias that was likely to be caused by the overrepresentation of positive trials (Figure S2), and the Egger test indicated publication bias (t=−4.89, p=0.0014).”
Quote in the paperNot a substantial claim - Also stated in: § Quality assessment and publication bias · hedged
- Study design and conductown data
Risk of bias was rated as low for random sequence generation in four RCTs.
“The risk of bias was rated as low concerning randomized generation of the allocation sequence in four RCTs, allocation concealment in one RCT, masking of outcome assessors to treatment allocation in five RCTs, incomplete outcome data in seven RCTs, and selective reporting in eight RCTs (Figure S1).”
Quote in the paperNot a substantial claim - Interpretationreasoning
The probable reason for the non-significant effect in children with anxiety is that bibliotherapy resulted in greater discontinuation from participation than did control conditions.
“The probable reason is that bibliotherapy resulted in greater discontinuation from participation than did control conditions.”
Quote in the paperSubstantial claim - Study design and conductown data
We could not include data on adverse effects or cost-effectiveness because of lacking data.
“Third, the funnel plot indicated a certain publication bias, so caution is required in interpreting our findings; we could not include data on adverse effects or cost-effectiveness because of lacking data, although these variables are important for clinical decisions.”
Quote in the paperNot a substantial claim - Interpretationreasoning
Bibliotherapy may be effective in children and adolescents with depression and/or anxiety problems.
“All this inferred that bibliotherapy may be effective in children and adolescents with depression and (or) anxiety problems.”
Quote in the paperSubstantial claim- Rests on an assumption: Bibliotherapy incorporates the foundational principles of CBT and provides exercises designed to help readers overcome negative feelings.
- Premisecitation
Bibliotherapy is not suitable for some people who lack cognitive capacity and self-discipline.
“These findings highlight an important caveat to the use of bibliotherapy that bibliotherapy is not suitable for some people who lack cognitive capacity and self-discipline.33”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [33] Rapee RM Abbott MJ Lyneham HJ Bibliotherapy for children with anxiety disorders using written materials for parents: a randomized controlled trial J Consult Clin Psychol 2006 74 3 436 444 16822101 source
- Study design and conductown data
Six of eight studies reviewed reported no follow-up assessment with bibliotherapy versus control comparison.
“Fourth, six of eight studies reviewed reported no follow-up assessment with bibliotherapy versus control comparison.”
Quote in the paperSubstantial claim - Premisecitation
A pilot study demonstrated a significant improvement in anxiety symptoms over time with a home-focused bibliotherapy intervention for children with anxiety disorder.
“A pilot study explored a home-focused bibliotherapy intervention for children with anxiety disorder and demonstrated a significant improvement in anxiety symptoms over time.51”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [51] Leong J Cobham V de Groot J McDermott B Comparing different modes of delivery: a pilot evaluation of a family-focused, cognitive-behavioral intervention for anxiety-disordered children Eur Child Adolesc Psychiatry 2009 18 4 231 239 19165538 source
- Study design and conductown data
Risk of bias was rated as low for masking of outcome assessors to treatment allocation in five RCTs.
“The risk of bias was rated as low concerning randomized generation of the allocation sequence in four RCTs, allocation concealment in one RCT, masking of outcome assessors to treatment allocation in five RCTs, incomplete outcome data in seven RCTs, and selective reporting in eight RCTs (Figure S1).”
Quote in the paperNot a substantial claim - Study design and conductown data
Risk of bias was rated as low for incomplete outcome data in seven RCTs.
“The risk of bias was rated as low concerning randomized generation of the allocation sequence in four RCTs, allocation concealment in one RCT, masking of outcome assessors to treatment allocation in five RCTs, incomplete outcome data in seven RCTs, and selective reporting in eight RCTs (Figure S1).”
Quote in the paperNot a substantial claim - Study design and conductown data
All the outcomes in the two studies using Educational Brochure Control Condition as PBO relied on youth self-report.
“First, all the outcomes relied on youth self-report.”
Quote in the paperNot a substantial claim - Study design and conductreasoning
We could not examine long-term effects of treatments.
“Hence, we could not examine long-term effects of treatments.”
Quote in the paperSubstantial claim - Study design and conductown data
The selected studies included only adolescents with depressive symptoms or children with anxiety symptoms.
“Second, selected study included only adolescents with depressive symptoms or child with anxiety symptoms, so further research on adolescents with anxiety and children with depression is needed.”
Quote in the paperSubstantial claim - Study design and conductown data
Risk of bias was rated as low for selective reporting in eight RCTs.
“The risk of bias was rated as low concerning randomized generation of the allocation sequence in four RCTs, allocation concealment in one RCT, masking of outcome assessors to treatment allocation in five RCTs, incomplete outcome data in seven RCTs, and selective reporting in eight RCTs (Figure S1).”
Quote in the paperNot a substantial claim - Study design and conductnone given
The overall quality of the included studies was low.
“In addition, the overall quality of the studies was low; therefore, results of moderator analyses should be interpreted with caution.”
Quote in the paperSubstantial claim - Premisecitation
Guidance toward appropriate books from a trained clinician is not widely available.
“However, guidance toward appropriate books from a trained clinician is not widely available.25”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [25] Mendel M Harris J Carson N Bringing bibliotherapy for children to clinical practice J Am Acad Child Adolesc Psychiatry 2016 55 7 535 537 27343878 source
- Study design and conductreasoning
The broad nature of our inclusion criteria created significant heterogeneity.
“First, while the broad nature of our inclusion criteria aimed to draw together literature from across child and adolescent studies, this was also a limitation as it created significant heterogeneity.”
Quote in the paperNot a substantial claim
- Classified as probably not a substantial claim. 37
- May combine two claims. 23
- The quote only partly states this claim. 2
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationA number of reviews demonstrate that self-help interventions are effective for depression and anxiety in adults.
“A number of reviews demonstrate that self-help interventions are effective for depression and anxiety in adults.21,22”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [21] Matcham F Rayner L Hutton J Monk A Steel C Hotopf M Self-help interventions for symptoms of depression, anxiety and psychological distress in patients with physical illnesses: a systematic review and meta-analysis Clin Psychol Rev 2014 34 2 141 157 24508685 source
The Discussion reports a small significant benefit for depression, but no significant overall benefit for anxiety. The Conclusions say theoretically based self-help materials may modestly improve both outcomes in patients with physical illness. That cautious, population-specific finding does not establish effectiveness for depression and anxiety in adults generally. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [22] Cuijpers P Donker T van Straten A Li J Andersson G Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies Psychol Med 2010 40 12 1943 1957 20406528 source
Classified as probably not a substantial claim.
PremisecitationCognitive 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”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [11] James A James G Cowdrey F Soler A Choke A Cognitive behavioural therapy for anxiety disorders in children and adolescents Cochrane Database Syst Rev 2013 6 CD004690 23733328 source
- cites [16] Zhou X Hetrick SE Cuijpers P Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: a systematic review and network meta-analysis World Psychiatry 2015 14 2 207 222 26043339 PMC4471978 source
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
May combine two claims.
PremisecitationLow availability or accessibility of CBT may be because of lack of identification, stigma, or difficulty in accessing services.
“This may be because of lack of identification, stigma, or difficulty in accessing services.18,19”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [18] Owens P Hoagwood K Horwitz S Barriers to children’s mental health services J Am Acad Child Adolesc Psychiatry 2002 41 6 731 738 12049448 source
- cites [19] Polaha J Williams S Heflinger C Studts C The perceived stigma of mental health services among rural parents of children with psychosocial concerns J Pediatr Psychol 2015 40 10 1095 1104 26071754 PMC4643638 source
The sections “Individual and Family Factors Influencing Access” and “Barriers to Getting Help for My Child” (page numbers unavailable) describe stigma and practical barriers to accessing children’s mental health services. The copy does not establish lack of identification as a barrier or address the availability or accessibility of CBT specifically. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationA potential negative effect of self-help treatments is delayed help-seeking, which could result in further deterioration of symptoms if the initial self-help treatment is not sufficient.
“However, the potential negative effect could be that self-help treatments could lead to a delayed help-seeking, which could result in further deterioration of symptoms, if the initial self-help treatment should be not sufficient.23”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [23] Ebert D Donkin L Andersson G Does Internet-based guided-self-help for depression cause harm? An individual participant data meta-analysis on deterioration rates and its moderators in randomized controlled trials Psychol Med 2016 46 13 2679 2693 27649340 PMC5560500 source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationBibliotherapy has been found to be efficacious by several systematic reviews or meta-analyses in the treatment of emotional, physical, and mental health problems among adults.
“Bibliotherapy has been found to be efficacious by several systematic reviews or meta-analyses in the treatment of emotional, physical, and mental health problems among adults.22,28–32”
Quote in the paperNot a substantial claim1 of 6 sources checked- cites [22] Cuijpers P Donker T van Straten A Li J Andersson G Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies Psychol Med 2010 40 12 1943 1957 20406528 source
- cites [28] McNaughton J Brief interventions for depression in primary care: a systematic review Can Fam Physician 2009 55 8 789 796 19675262 PMC2726093
- cites [29] Fiske A Wetherell J Gatz M Depression in older adults Annu Rev Clin Psychol 2009 5 363 389 19327033 PMC2852580 source
The Abstract and ‘Evidence Based Treatments’ section identify cognitive bibliotherapy as effective for depression in older adults. They do not establish efficacy for emotional, physical, and mental health problems broadly among adults, or say that several systematic reviews or meta-analyses reached that conclusion. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [30] Newman MG Erickson T Przeworski A Dzus E Self-help and minimal-contact therapies for anxiety disorders: is human contact necessary for therapeutic efficacy? J Clin Psychol 2003 59 3 251 274 12579544 source
- cites [31] Cuijpers P Bibliotherapy in unipolar depression: a meta-analysis J Behav Ther Exp Psychiatry 1997 28 2 139 147 9194011 source
- cites [32] Gould RA Clum GA A meta-analysis of self-help treatment approaches Clin Psychol Rev 1993 13 2 169 186
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe main advantages of bibliotherapy are its ease of use, low cost, low staffing demands, and greater privacy.
“In addition, the main advantages are its ease of use, low cost, low staffing demands, and greater privacy.26,27”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [26] Lewis C Pearce J Bisson J Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: systematic review Br J Psychiatry 2012 200 1 15 21 22215865 source
The introductory passage describes self-help, including books, as requiring little or no therapist input, and the Limitations section describes pure self-help as lower-cost and more accessible. The paper does not establish ease of use or greater privacy as advantages of bibliotherapy. Its Main findings also say the included studies lacked economic evaluations, so lower cost should not be read as demonstrated cost-effectiveness. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [27] Shoshani Helvitz I Bibliotherapy as a clinical tool and its applications in diagnosis, treatment and teaching medicine Harefuah 2016 155 12 770 773 Hebrew 28530338
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationCBT 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”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [11] James A James G Cowdrey F Soler A Choke A Cognitive behavioural therapy for anxiety disorders in children and adolescents Cochrane Database Syst Rev 2013 6 CD004690 23733328 source
- cites [16] Zhou X Hetrick SE Cuijpers P Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: a systematic review and network meta-analysis World Psychiatry 2015 14 2 207 222 26043339 PMC4471978 source
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
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationParents are more likely to support their children when they display negative emotions or mood disorders.
“Some previous research has shown that parents are more likely to support their children when they display negative emotions or mood disorders.55”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [55] Hudson JL Comer JS Kendall PC Parental responses to positive and negative emotions in anxious and nonanxious children J Clin Child Adolesc Psychol 2008 37 2 303 313 18470768 PMC2677179 source
The Discussion (page not provided) says parents may provide more assistance when a child is distressed than when the child is happy. But it characterizes that assistance as intrusive involvement, not necessarily support; the Results (page not provided) also report more nonsupportive responses to negative emotions among parents of anxious children. The paper does not establish the claim for mood disorders generally. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationcitationA 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”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [16] Zhou X Hetrick SE Cuijpers P Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: a systematic review and network meta-analysis World Psychiatry 2015 14 2 207 222 26043339 PMC4471978 source
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
Classified as probably not a substantial claim.
InterpretationcitationTrials with smaller sample sizes might result in an exaggerated treatment effect.
“The sensitivity analysis indicated that bibliotherapy was not significantly more effective in trials with large samples; however, a possible explanation is that trials with smaller sample sizes might result in an exaggerated treatment effect.53”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [53] Biau DJ Kerneis S Porcher R Statistics in brief: the importance of sample size in the planning and interpretation of medical research Clin Orthopaed Relat Res 2008 466 9 2282 2288 PMC2493004 18566874 source
May combine two claims.
PremisecitationYouth depression and anxiety symptoms highly correlate and can be treated by combined interventions.
“Given that youth depression and anxiety symptoms highly correlate8 and can be treated by combined interventions, we examined the overall effects of all interventions on symptoms of anxiety and depression in a common analysis.34”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [8] Cummings C Caporino N Kendall P Comorbidity of anxiety and depression in children and adolescents: 20 years after Psychol Bull 2014 140 3 816 845 24219155 PMC4006306 source
The Comorbidity section reports that depression and anxiety often co-occur in youth, supporting a relationship between the symptoms, though it does not establish how strongly they correlate. The Treating Comorbid Anxiety and Depression section describes interventions targeting both conditions, but says the available data are preliminary and trials are needed to establish their efficacy; it does not establish that combined interventions successfully treat both. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAcceptability may be influenced by the views and concerns of the youths and/or their parents.
“In fact, in psychotherapy trials, acceptability may be more connected with treatment efficacy than tolerability, because few adverse effects are reported in these psychotherapy trials; in addition, acceptability may also be influenced by the views and concerns of the youths and/or their parents.36”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [36] Zhang Y Zhou X James AC Comparative efficacy and acceptability of psychotherapies for acute anxiety disorders in children and adolescents: study protocol for a network meta-analysis BMJ Open 2015 5 10 e008572 PMC4606384 26443658 source
May combine two claims.
Findingown dataEight studies including 979 participants met inclusion criteria and were included in the meta-analysis.
“Eight studies with 979 participants were selected.”
- Also stated in: § Study selection and characteristics · plain
“Finally, eight studies33,41–47 including 979 patients met all our inclusion criteria and were included in this meta-analysis.”
Quote in the paperSubstantial claim- Also stated in: § Study selection and characteristics · plain
May combine two claims.
Findingown dataAmong the three control conditions, bibliotherapy was significantly more beneficial than WL and NT.
“Among the three control conditions, bibliotherapy was significantly more beneficial than WL and NT, whereas it was not better than PBO.”
Quote in the paperSubstantial claimMay combine two claims.
FindingreasoningFor anxiety in children, bibliotherapy seemed better than control, but not significantly different from zero.
“For anxiety in children, bibliotherapy seemed better than control, but not significantly different from zero.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
FindingcitationThe most common books used were Feeling Good and Helping Your Anxious Child: A Step by Step Guide.
“The most common books used were Feeling Good56 and Helping Your Anxious Child: A Step by Step Guide.57”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [56] Burns DD Feeling Good – The New Mood Therapy New York Avon Books 1999
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [57] Rapee RM Spence SH Cobham VE Wignall A Helping Your Anxious Child: A Step-by-Step Guide for Parents Oakland, CA New Harbinger 2000
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationGould and Clum reviewed self-help treatments and reported an effect size of 0.74 for three depression bibliotherapy studies.
“Gould and Clum32 reviewed self-help treatments and reported an effect size of 0.74 for three depression bibliotherapy studies.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [32] Gould RA Clum GA A meta-analysis of self-help treatment approaches Clin Psychol Rev 1993 13 2 169 186
Not checked in the free run.
May combine two claims.
Interpretationown dataBibliotherapy may be more beneficial in treating depression in adolescents, but shows less robust effects for anxiety in children.
“According to the findings in this review, bibliotherapy may be more beneficial in treating depression in adolescents, but shows less robust effects for anxiety in children.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
PremisecitationSeveral clinical guidelines recommend that psychological treatments are still considered the mainstay of treatments for depression and anxiety disorders in children and adolescents.
“Currently, several clinical guidelines recommend that psychological treatments are still considered the mainstay of treatments for depression and anxiety disorders in children and adolescents.10,15”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [10] Hopkins K Crosland P Elliott N Bewley S Diagnosis and management of depression in children and young people: summary of updated NICE guidance BMJ 2015 350 h824 25739880 source
- cites [15] Malhi GS Bassett D Boyce P Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders Aust N Z J Psychiatry 2015 49 12 1087 1206 26643054 source
May combine two claims.
PremisecitationDespite a strong evidence base for CBT, the availability or accessibility of the therapy is low, especially in low- and middle-income countries.
“Despite strong evidence base for CBT, the availability or accessibility of the therapy is low,17 especially in low- and middle-income countries.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17] Olfson M Marcus SC National trends in outpatient psychotherapy Am J Psychiatry 2010 167 12 1456 1463 20686187 source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationNewman et al. reviewed bibliotherapy for anxiety disorders and concluded that bibliotherapy demonstrated efficacy for the greatest variety of anxiety diagnoses.
“Newman et al30 reviewed bibliotherapy for anxiety disorders and concluded that bibliotherapy demonstrated efficacy for the greatest variety of anxiety diagnoses.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [30] Newman MG Erickson T Przeworski A Dzus E Self-help and minimal-contact therapies for anxiety disorders: is human contact necessary for therapeutic efficacy? J Clin Psychol 2003 59 3 251 274 12579544 source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenAn intention-to-treat analysis was conducted.
“An intention-to-treat analysis was conducted.”
- Also stated in: § Statistical analysis · plain
“Also, we used the intention-to-treat population for analyses.”
Quote in the paperNot a substantial claim- Also stated in: § Statistical analysis · plain
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationCuijpers reported an effect size of 0.83 in his meta-analysis of seven depression bibliotherapy studies.
“Cuijpers31 reported an effect size of 0.83 in his meta-analysis of seven depression bibliotherapy studies.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [31] Cuijpers P Bibliotherapy in unipolar depression: a meta-analysis J Behav Ther Exp Psychiatry 1997 28 2 139 147 9194011 source
Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).
PremisecitationMinimal phone contact with a therapist is vital in encouraging higher rates of program completion.
“Researchers have suggested that minimal phone contact with a therapist is vital in encouraging higher rates of program completion.30”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [30] Newman MG Erickson T Przeworski A Dzus E Self-help and minimal-contact therapies for anxiety disorders: is human contact necessary for therapeutic efficacy? J Clin Psychol 2003 59 3 251 274 12579544 source
May combine two claims.
PremisecitationIn bibliotherapy studies of anxiety disorders in other populations, predictors of positive treatment outcome have included participants' motivation for treatment, compliance with program materials, and less complex/severe initial presentations.
“These experiences were consistent with the findings from bibliotherapy studies of anxiety disorders in other populations, where predictors of positive treatment outcome have included participants’ motivation for treatment, compliance with program materials, and less complex/severe initial presentations.27,30,44”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [27] Shoshani Helvitz I Bibliotherapy as a clinical tool and its applications in diagnosis, treatment and teaching medicine Harefuah 2016 155 12 770 773 Hebrew 28530338
- cites [30] Newman MG Erickson T Przeworski A Dzus E Self-help and minimal-contact therapies for anxiety disorders: is human contact necessary for therapeutic efficacy? J Clin Psychol 2003 59 3 251 274 12579544 source
- cites [44] Lyneham HJ Rapee RM Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children Behav Res Ther 2006 44 9 1287 1300 16313883 source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe UK National Institute for Clinical Excellence has recommended bibliotherapy as a treatment for unrelenting subthreshold depressive symptoms or mild-to-moderate depression.
“The UK National Institute for Clinical Excellence has recommended bibliotherapy as a treatment for unrelenting subthreshold depressive symptoms or mild-to-moderate depression.59”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [59] National Institute for Health and Clinical Excellence (NICE) Depression in adults Available from: http://https://www.nice.org.uk/guidance/qs8 Accessed January 1, 2018
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitationPublication bias was examined with the funnel plot method and the Egger regression asymmetry test.
“Publication bias was examined with the funnel plot method and the Egger regression asymmetry test.40”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [40] Egger M Davey Smith G Schneider M Minder C Bias in meta-analysis detected by a simple, graphical test BMJ 1997 315 7109 629 634 9310563 PMC2127453 source
Classified as probably not a substantial claim.
InterpretationcitationBibliotherapy programs for children can make use of a possible motivating factor that exists in the children's daily environment by using the parents' desire for their children to change.
“In this situation, bibliotherapy programs for children can make use of a possible motivating factor that exists in the children’s daily environment by using the parents’ desire for their children to change.33,49”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [33] Rapee RM Abbott MJ Lyneham HJ Bibliotherapy for children with anxiety disorders using written materials for parents: a randomized controlled trial J Consult Clin Psychol 2006 74 3 436 444 16822101 source
- cites [49] Sampaio F Enebrink P Mihalopoulos C Feldman I Cost-effectiveness of four parenting programs and bibliotherapy for parents of children with conduct problems J Ment Health Policy Econ 2016 19 4 201 212 27991419
Classified as probably not a substantial claim.
InterpretationreasoningBecause of the different clinical conditions and settings represented in the studies, data sets on efficacy were expected to be heterogeneous.
“Because of the different clinical conditions and settings represented in the studies, we expected that data sets on efficacy would be heterogeneous.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningFamily-focused bibliotherapy for children through their parents may be more acceptable and effective.
“Hence, family-focused bibliotherapy for children through their parents may be more acceptable and effective.”
Quote in the paperSubstantial claim- Rests on an assumption: Children usually have established trust and rapport with their parents.
- Rests on an assumption: Parents are more broadly present and available in their children’s life.
Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.
InterpretationreasoningOur results were in agreement with the prior evidence on Feeling Good.
“Our results were in agreement.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenSome patients (n=19) did not participate in posttreatment assessments.
“Second, some patients (n=19) did not participate in posttreatment assessments.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
InterpretationcitationA family-focused intervention may be optimal in addressing the interpersonal problems and symptoms frequently evident among depressed children during this developmental phase.
“A family-focused intervention may be optimal in addressing the interpersonal problems and symptoms frequently evident among depressed children during this developmental phase.50”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [50] Ciechanowski P Wagner E Schmaling K Community-integrated home-based depression treatment in older adults: a randomized controlled trial JAMA 2004 291 13 1569 1577 15069044 source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataTwo independent reviewers selected studies for inclusion, with divergences resolved by consensus.
“Two independent reviewers (SY and YQZ) selected studies for inclusion, with divergences resolved by consensus.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
InterpretationreasoningPatients with such expectations who are confronted with an independent and active model of therapeutic change may be discouraged.
“whereas patients with such expectations who are confronted with an independent and active model of therapeutic change may be discouraged.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductreasoningThe clinical interpretation of these findings is limited by the uncertainty around these estimates, the potential bias due to publication, and the small number of trials in each group.
“The clinical interpretation of these findings is limited not only by the uncertainty around these estimates but also by the potential bias due to publication and the small number of trials in each group.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductown dataThere was no indication of differential attrition across intervention conditions or as a function of demographic variables.
“Although there was no indication of differential attrition across intervention conditions or as a function of demographic variables, it is possible that incidence of depressive episodes might have been higher with a complete sample.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataRisk of bias was rated as low for allocation concealment in one RCT.
“The risk of bias was rated as low concerning randomized generation of the allocation sequence in four RCTs, allocation concealment in one RCT, masking of outcome assessors to treatment allocation in five RCTs, incomplete outcome data in seven RCTs, and selective reporting in eight RCTs (Figure S1).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationHelping Your Anxious Child: A Step-by-Step Guide describes anxiety management skills and ways of introducing them to and implementing them with children; it was used in two included studies.
“Helping Your Anxious Child: A Step-by-Step Guide describes anxiety management skills and ways of introducing them to and implementing them with children; it was used in two included studies.33,44”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [33] Rapee RM Abbott MJ Lyneham HJ Bibliotherapy for children with anxiety disorders using written materials for parents: a randomized controlled trial J Consult Clin Psychol 2006 74 3 436 444 16822101 source
- cites [44] Lyneham HJ Rapee RM Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children Behav Res Ther 2006 44 9 1287 1300 16313883 source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationFeeling Good presents a self-administered version of cognitive therapy for depression.
“Feeling Good presents a self-administered version of cognitive therapy for depression.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [56] Burns DD Feeling Good – The New Mood Therapy New York Avon Books 1999
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
The quote only partly states this claim.
PremisecitationClinically and statistically significant improvements in depression were evidenced with Feeling Good.
“Clinically and statistically significant improvements in depression were evidenced.58”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [58] Scogin F Jamison C Davis N Two-year follow-up of bibliotherapy for depression in older adults J Consult Clin Psychol 1990 58 5 665 667 2254516 source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataA sensitivity analysis excluding studies with small sample sizes (≤50 patients) was performed.
“Moreover, we performed sensitivity analyses, omitting studies that involved small sample sizes (≤50 patients).”
- Also stated in: § Sensitivity analysis · plain
“We performed a sensitivity analysis by excluding the studies that involved small sample sizes (≤50 patients).”
Quote in the paperNot a substantial claim- Also stated in: § Sensitivity analysis · plain
May combine two claims.
PremisecitationRapee et al. conducted the first study evaluating bibliotherapy with anxiety-disordered children and demonstrated the bibliotherapy benefit for anxiety in children.
“Rapee et al33 conducted the first study evaluating bibliotherapy with anxiety-disordered children and demonstrated the bibliotherapy benefit for anxiety in children.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [33] Rapee RM Abbott MJ Lyneham HJ Bibliotherapy for children with anxiety disorders using written materials for parents: a randomized controlled trial J Consult Clin Psychol 2006 74 3 436 444 16822101 source
May combine two claims.
Study design and conductown dataEnough data were not available to draw a reliable conclusion; the long-term effects of the treatments could not be examined.
“Enough data are not available to draw a reliable conclusion. Hence, we were not able to examine the long-term effects of the treatments.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataBibliotherapy may be an effective and acceptable psychological treatment for depression in adolescents.
“Our review supports the notion that bibliotherapy may be an effective and acceptable psychological treatment for depression in adolescents and show less robust effects for anxiety in children.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataTwo independent researchers extracted the data and assessed the risk of bias.
“Two independent researchers (SY and YZ) extracted the data and assessed the risk of bias.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationRapee et al conducted the first study evaluating Helping Your Anxious Child: A Step-by-Step Guide with anxiety-disordered children.
“Rapee et al33 conducted the first study evaluating Helping Your Anxious Child: A Step-by-Step Guide with anxiety-disordered children.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [33] Rapee RM Abbott MJ Lyneham HJ Bibliotherapy for children with anxiety disorders using written materials for parents: a randomized controlled trial J Consult Clin Psychol 2006 74 3 436 444 16822101 source
Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningIt is possible that incidence of depressive episodes might have been higher with a complete sample.
“Although there was no indication of differential attrition across intervention conditions or as a function of demographic variables, it is possible that incidence of depressive episodes might have been higher with a complete sample.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationChildren live under the care and guidance of an adult, making them especially amenable to bibliotherapy led by an adult, most commonly a parent.
“Children live under the care and guidance of an adult, making them especially amenable to bibliotherapy led by an adult, most commonly a parent.33”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [33] Rapee RM Abbott MJ Lyneham HJ Bibliotherapy for children with anxiety disorders using written materials for parents: a randomized controlled trial J Consult Clin Psychol 2006 74 3 436 444 16822101 source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenPoor methodology, risk of bias within individual studies, and potential selective reporting are important factors to be considered when interpreting the results from this meta-analysis.
“Moreover, poor methodology, risk of bias within individual studies, and potential selective reporting are important factors to be considered when interpreting the results from this meta-analysis.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
PremisecitationPatients using psychotherapy often expect guidance and advice from experts who assume some degree of responsibility and control, which reduces the pressure on the patients.
“Patients using psychotherapy often expect guidance and advice from experts who assume some degree of responsibility and control, which reduces the pressure on the patients,52”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [52] Sánchez-Bahíllo Á Aragón-Alonso A Sánchez-Bahíllo M Birtle J Therapist characteristics that predict the outcome of multipatient psychotherapy: systematic review of empirical studies J Psychiatr Res 2014 53 149 156 24582149 source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe risk of bias in trials was assessed using the risk of bias tool from the Cochrane Handbook.
“The researchers also assessed the risk of bias in trials using the risk of bias tool from the Cochrane Handbook.37”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [37] Higgins J Green S Cochrane handbook for systematic reviews of interventions. Version 5.1.0 Updated March 2011. Available from: http://handbook-5-1.cochrane.org/ Accessed January 1, 2018
Not checked in the free run.
The paper relies on this without support.
Few meta-analyses have focused on the effect of bibliotherapy alone on depression and anxiety disorders in children and adolescents.
“Yet few meta-analyses have focused on the effect of bibliotherapy on depression and anxiety disorders in children and adolescents.”
“Nonetheless, few meta-analyses have focused on the effect of bibliotherapy alone on depression and anxiety disorders in children and adolescents.”
The authors state this as an assumption.
The true treatment effect may vary among studies.
“Considering the underlying heterogeneity and our assumption that the true treatment effect may vary among studies, we used DerSimonian and Laird38 random-effects model for our meta-analyses.39”
The paper relies on this without support.
Bibliotherapy incorporates the foundational principles of CBT and provides exercises designed to help readers overcome negative feelings.
“Bibliotherapy incorporates the foundational principles of CBT and provides exercises designed to help the readers overcome negative feelings.”
The paper relies on this without support.
Bibliotherapy reduces the impact of stigma and the time burden associated with visiting a clinic.
“Bibliotherapy reduces both the impact of stigma (as it is possible to access it without the knowledge of others) and the time burden associated with visiting a clinic.”
The paper relies on this without support.
High rates of attrition have long been noted as a difficulty with self-help programs.
“High rates of attrition have long been noted as a difficulty with self-help programs.”
The paper relies on this without support.
Children usually have established trust and rapport with their parents.
“The potential advantages of targeting parents in bibliotherapy are that 1) children usually have established trust and rapport with their parents and 2) parents are more broadly present and available in their children’s life.”
The paper relies on this without support.
Parents are more broadly present and available in their children’s life.
“The potential advantages of targeting parents in bibliotherapy are that 1) children usually have established trust and rapport with their parents and 2) parents are more broadly present and available in their children’s life.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the meta-analysis by Yuan et al., participants receiving bibliotherapy showed significant reductions in depression scores, with effects maintained during follow-up.
“The analysis also found that participants receiving bibliotherapy appeared to showed significant reductions in depression scores, with effects maintained during follow-up.”
From Recent developments in bibliotherapy for adolescent depression (2025) · cites this paper as [44]
The Results (Subgroup analysis) report significantly lower depression symptoms with bibliotherapy than with controls in studies of depressive patients. But Results (Study selection and characteristics) says there were insufficient follow-up data to examine long-term effects, so the claim that the effects were maintained during follow-up is unsupported. (LLM, conf=0.92)
Experimental — accuracy not yet measuredBibliotherapy demonstrated high acceptability and low dropout rates in the meta-analysis by Yuan et al.
“Additionally, the therapy demonstrated high acceptability and low dropout rates, making it particularly suitable for adolescents with mild to moderate depression (44).”
From Recent developments in bibliotherapy for adolescent depression (2025) · cites this paper as [44]
The Conclusion describes bibliotherapy as a potentially acceptable treatment for depression in adolescents. However, the Discussion says all-cause discontinuation in bibliotherapy groups remained high, contrary to the claim of low dropout. The cited passages also do not establish particular suitability for mild to moderate depression. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBibliotherapy is particularly suitable for adolescents with mild to moderate depression.
“Additionally, the therapy demonstrated high acceptability and low dropout rates, making it particularly suitable for adolescents with mild to moderate depression (44).”
From Recent developments in bibliotherapy for adolescent depression (2025) · cites this paper as [44]
The Conclusion says bibliotherapy may be an effective and acceptable treatment for depression in adolescents, and the Introduction reports a recommendation for mild-to-moderate depression. But the paper does not establish that it is particularly suitable for adolescents with that severity of depression. The citing sentence’s claim of low dropout rates also conflicts with the Discussion, which says discontinuation in bibliotherapy groups remained high. (LLM, conf=0.86)
Experimental — accuracy not yet measuredA meta-analysis by Yuan et al. of RCTs targeting depression and anxiety in children and adolescents reported an SMD of -0.52 (95% CI: -0.89 to -0.15), suggesting a moderate intervention effect.
“A meta-analysis by Yuan et al. (44) synthesized multiple randomized controlled trials targeting depression and anxiety in children and adolescents, reporting a standardized mean difference (SMD) of –0.52 (95% CI: –0.89 to –0.15), suggesting a moderate intervention effect.”
From Recent developments in bibliotherapy for adolescent depression (2025) · cites this paper as [44]
Bibliotherapy may have a certain effect in alleviating depressive symptoms in adolescents.
“Research indicates that bibliotherapy may have a certain effect in alleviating depressive symptoms in adolescents.”
From Recent developments in bibliotherapy for adolescent depression (2025) · cites this paper as [44]
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 [44]
The Introduction describes self-help bibliotherapy, and the Discussion reports improvements in depression, but neither links those improvements to the development of self-identity. Searches for self-identity, resilience, and their connection to depressive symptoms found no passage addressing the claim; page numbers were not available in our copy. (LLM, conf=0.74)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Study-selection counts leave 130 records unaccounted for
MinorAfter 832 of the 999 potentially relevant records were excluded, 167 remained, not the 37 reported as read by reviewers. The text does not account for the other 130 records.
Reported 37 · recomputed 167
“After excluding 291 duplicate records, we retrieved 999 potentially relevant studies. Of these, 832 articles were excluded because of irrelevant titles and abstracts. Then, 37 studies were read independently by two reviewers (SY and YZ).”
Primary result reverses which group had the advantage
MinorThe efficacy-results section says the pooled effect showed an advantage over bibliotherapy, whereas the abstract says bibliotherapy was significantly more effective than controls.
“The overall pooled effect size indicated a significant advantage over bibliotherapy at posttreatment, with an SMD of −0.52 (95% CI, −0.89 to −0.15; p=0.006).”
“At posttreatment, bibliotherapy was significantly more effective than the control conditions in reducing the symptoms of depression or anxiety (standardized mean difference, −0.52; 95% confidence interval [CI], −0.89 to −0.15).”
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“Currently, several clinical guidelines recommend that psychological treatments are still considered the mainstay of treatments for depression and anxiety disorders in children and adolescents.(10,15) Cognitive behavioral therapy (CBT) is generally regarded as the treatment of choice for depression and anxiety in child…”
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“14 Currently, several clinical guidelines recommend that psychological treatments are still considered the mainstay of treatments for depression and anxiety disorders in children and adolescents.”
Barriers to children's mental health services
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Practitioner Review: Anxiety disorders in children and young people – assessment and treatment
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- Authors
- Yuan, S., Zhou, X., Zhang, Y., Zhang, H., Pu, J., Yang, L., Liu, L., Jiang, X., & Xie, P.
- Affiliations
- Chongqing Medical University (CN)
- The Affiliated Yongchuan Hospital of Chongqing Medical University (CN)
- Corresponding author
- Xie, Peng
- Venue
- Neuropsychiatric Disease and Treatment
- Publisher
- Informa UK Limited
- Published
- 2018-01
- Volume
- Volume 14
- Pages
- 353-365
- ISSN
- 1176-6328 (ISSN-L)
- 1178-2021
- PMC
- PMC5788928
- OpenAlex
- W2784460425
- Semantic Scholar
- ab7a9043a8077fdda8ffb4717574d0358ba28b32
- Cited by
- 83
- References
- 63
- Citations by year
- 2026: 11 · 2025: 12 · 2024: 17 · 2023: 9 · 2022: 14 · 2021: 9 · 2020: 6 · 2019: 4 · 2018: 1
- FWCI
- 5.87
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Neuropsychiatric Disease and Treatment (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- PubMed Central (submittedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Funders
- National Natural Science Foundation of China (973 Program, 31300881, 2009CB918300)
- National Key Research and Development Program of China (2009CB918300)
- Topics
- Social Sciences › Arts and Humanities › Conservation › Art Therapy and Mental Health
- Social Sciences › Psychology › Clinical Psychology › Child Therapy and Development
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- bibliotherapy, depression, anxiety disorders, children, adolescents, treatment efficacy, treatment acceptability, treatment discontinuation, parental involvement
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