European Child & Adolescent Psychiatry

, Volume 15, Issue 5, pp 300–307 | Cite as

Screening and early psychological intervention for depression in schools

Systematic review and meta-analysis
  • Pim Cuijpers
  • Annemieke van Straten
  • Niels Smits
  • Filip Smit
ORIGINAL CONTRIBUTION

Abstract

Depression in children and adolescents is considerably undertreated, and the school may be a good setting for identifying and treating depression. We conducted a meta-analysis of studies in which students were screened for depression, and those with depressive symptoms were treated with a psychological intervention. Only randomised controlled trials were included. Eight studies met the inclusion criteria. Five studies focused on younger children (7–14 years) and three studies were aimed at adolescents (12–19 years). In total 5803 students were screened, of whom 7.2% were included in the intervention studies (95% CI: 7.1–7.3). The ‘numbers-needed-to-screen’ was 31 (95% CI: 27–32), which means that 31 students had to be screened in order to generate one successfully treated case of depression. The effects of the psychological treatments at post-test were compared to control conditions in the 8 studies comprising 12 contrast groups, with a total of 413 students. The mean effect size was 0.55 (95% CI: 0.35–0.76). There were not enough studies to examine whether specific psychotherapies were superior to other psychotherapies. Although the number of studies is small and their quality is limited, screening and early intervention at schools may be an effective strategy to reduce the burden of disease from depression in children and adolescents. More research on the (negative) effects of these interventions is needed.

Keywords

depression children adolescents psychological treatment meta-analysis 

References

  1. 1.
    American Academy of Child and Adolescent Psychiatry (1998) Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry 37(10suppl):63S–83SGoogle Scholar
  2. 2.
    Asarnow JR, Jaycox LH, Tompson MC (2001) Depression in youth: psychosocial interventions. J Clin Child Psychol 30:33–47PubMedCrossRefGoogle Scholar
  3. 3.
    Beich A, Thorsen T, Rollnick S (2003) Screening in brief intervention trials targeting excessive drinkers in general practice: systematic review and meta-analysis. BMJ 327:536–542PubMedCrossRefGoogle Scholar
  4. 4.
    Birmaher B, Ryan ND, Williamson DE, Brent DA, Kaufman J, Dahl RE, Perel J, Nelson B (1996) Childhood and adolescent depression, I: a review of the past 10 years. J Am Acad Child Adolsc Psychiatry 35:1427–1439CrossRefGoogle Scholar
  5. 5.
    Clarke GN, Hawkins W, Murphy M, Sheeber LB, Lewinsohn PM, Seeley JR (1995) Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: a randomized trial of a group cognitive intervention. J Am Acad Child Adolesc Psychiatry 34:312–321PubMedCrossRefGoogle Scholar
  6. 6.
    Clarke GN, Hornbrook M, Lynch F, Polen M, Gale J, Beardslee W, O’Connor E, Seeley J (2001) A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Arch Gen Psychiatry 58:1127–1134PubMedCrossRefGoogle Scholar
  7. 7.
    Cuijpers P, Dekker J (2005) Psychologische behandeling van depressie: een systematisch overzicht van meta-analyses. Ned Tijdschr Geneeskunde 149:1892–1897Google Scholar
  8. 8.
    Cuijpers P, Dekker J, van der Feltz-Cornelis C, Smit F (2006) Psychological treatment of depression: A systematic review of meta-analyses. SubmittedGoogle Scholar
  9. 9.
    De Cuyper S, Timbremont B, Braet C, De Backer V, Wullaert T (2004) Treating depressive symptoms in schoolchildren: a pilot study. Eur Child Adol Psychiatry 13:105–114CrossRefGoogle Scholar
  10. 10.
    Gillham JE, Shatté AJ, Freres DR (2000) Preventing depression: a review of cognitive-behavioral and family interventions. Appl Prev Psychol 9:63–88CrossRefGoogle Scholar
  11. 11.
    Haby MM, Tonge B, Littlefield L, Carter R, Vos T (2004) Cost-effectiveness of cognitive behavioural therapy and selective serotonin reuptake inhibitors for major depression in children and adolescents. Austr New Zealand J Psychiatry 38:579–591CrossRefGoogle Scholar
  12. 12.
    Harrington R, Whittaker J, Shoebridge P (1998) Systematic review of efficacy of cognitive behaviour therapies in childhood and adolescent depressive disorder. BMJ 316:1559–1563PubMedGoogle Scholar
  13. 13.
    Harrington R, Whittaker J, Shoebridge P, Campbell F (1998) Systematic review of efficacy of cognitive behaviour therapies in childhood and adolescent depressive disorder. BMJ 316:1559–1563PubMedGoogle Scholar
  14. 14.
    Harrington R, Clark A (1998) Prevention and early intervention for depression in adolescence and early adult life. Eur Arch Psychiatry Neurosci 248:32–45CrossRefGoogle Scholar
  15. 15.
    Higgins JPT, Green S (2005) Cochrane handbook for systematic reviews of interventions 4.2.5 [updated May 2005]. In: The Cochrane Library, Issue 3, 2005. John Wiley & Sons, Ltd., Chichester, UKGoogle Scholar
  16. 16.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327: 557–560PubMedCrossRefGoogle Scholar
  17. 17.
    Jaycox LH, Reivich KJ, Gillham J, Seligman MEP (1994) Prevention of depressive symptoms in school children. Behav Res Ther 32:801–816PubMedCrossRefGoogle Scholar
  18. 18.
    Kahn J, Kehle T, Jenson W, Clark E (1990) Comparison of cognitive-behavioral, relaxation, and self-modeling interventions for depression among middle-school students. School Psychol Rev 19:196–211Google Scholar
  19. 19.
    Lamb JM, Puskar KR, Sereika SM, Corcoran M (1998) School-based intervention to promote coping in rural teens. MCN Am J Matern Child Nurs 23:187–194PubMedCrossRefGoogle Scholar
  20. 20.
    Lewinsohn PM, Clarke GN (1999) Psychosocial treatments for adolescent depression. Clin Psychol Rev 19:329–342PubMedCrossRefGoogle Scholar
  21. 21.
    Lewinsohn PM, Hops H, Roberts RE, Seeley JR, Andrews JA (1993) Adolescent psychopathology, I: prevalence and incidence of depression and oterh DSM-III-R disorders in high school students. J Abnorm Psychol 102:133–144PubMedCrossRefGoogle Scholar
  22. 22.
    Liddle B, Spence SH (1990) Cognitive-behaviour therapy with depressed primary school children: a cautionary note. Behav Psychother 18:85–102CrossRefGoogle Scholar
  23. 23.
    Lipsey MW, Wilson DB (1993) The efficacy of psychological, educational and behavioral treatment. Amer Psychol 48:1181–1209CrossRefGoogle Scholar
  24. 24.
    Merry S, McDowell H, Hetrick S, Bir J, Muller N (2004) Psychological and/or educational interventions for the prevention of depression in children and adolescents. The Cochrane Database of Systematic Reviews Issue 2. Art. No.: CD003380. DOI: 10.1002/14651858.CD003380.pub2Google Scholar
  25. 25.
    Michael KD, Crowley SL (2002) How effective are treatments for child and adolescent depression? A meta-analytic review. Clin Psychol Rev 22:247–269PubMedCrossRefGoogle Scholar
  26. 26.
    Pine DS, Cohen P, Gurley D, Brook J, Ma Y (1998) The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Arch Gen Psychiatry 55:56–64PubMedCrossRefGoogle Scholar
  27. 27.
    Reinecke MA, Ryan NE, DuBois DL (1998) Cognitive-behavioral therapy of depression and depressive symptoms during adolescence: a review and meta-analysis. J Am Acad Child Adolesc Psychiatry 37:26–34PubMedCrossRefGoogle Scholar
  28. 28.
    Rembold CM (1998) Number needed to screen: development of a statistic for disease screening. BMJ 317:307–312PubMedGoogle Scholar
  29. 29.
    Reynolds W, Coats K (1986) A comparison of cognitive-behavior therapy an relaxation training for the treatment of depression in adolescents. J Consult Clin Psychol 54:653–660PubMedCrossRefGoogle Scholar
  30. 30.
    Roberts C, Kane R, Thomson H, Bishop B, Hart B (2003) The prevention of depressive symptoms in rural school children: a randomized controlled trial. J Consult Clin Psychol 71:622–628PubMedCrossRefGoogle Scholar
  31. 31.
    Ryan ND (2005) Treatment of depression in children and adolescents. Lancet 366:933–940PubMedCrossRefGoogle Scholar
  32. 32.
    Stark KD, Reynolds WM, Kaslow NJ (1987) A comparison of the relative efficacy of self-control therapy and a behavioral problem-solving therapy for depression in children. J Abnorm Child Psychol 15:91–113PubMedCrossRefGoogle Scholar
  33. 33.
    Weisz JR, Weiss B, Han SS, Granger DA, Morton T (1995) Effects of psychotherapy with children and adolescents revisited: a meta-analysis of treatment outcome studies. Psychol Bull 117:450–468PubMedCrossRefGoogle Scholar
  34. 34.
    Weisz JR, Thurber CA, Sweeney L, Proffit VD, LeGagnoux GL (1997) Brief treatment of mild-to-moderate child depression using primary and secondary control enhancement training. J Consult Clin Psychol 65:703–707PubMedCrossRefGoogle Scholar
  35. 35.
    Weisz JR, Hawley KM, Doss AJ, (2004) Empirically tested psychotherapies for youth internalizing and externalizing problems and disorders. Child Adolesc Psychiatr Clin N Am 13:729–815PubMedCrossRefGoogle Scholar
  36. 36.
    Yu DL, Seligman MEP (2002) Preventing depressive symptoms in Chinese children. Prev Treatm, Vol. 5 Webpage: http://www.journals.apa.org/prevention/volume5/toc-may08-02.htm
  37. 37.
    Zwaanswijk M, Verhaak PF, Bensing JM, van der Ende J, Verhulst FC (2003) Help seeking for emotional and behavioural problems in children and adolescents: a review of recent literature. Eur Child Adolesc Psychiatry 12:153–161PubMedCrossRefGoogle Scholar

Copyright information

© Steinkopff Verlag Darmstadt 2006

Authors and Affiliations

  • Pim Cuijpers
    • 1
  • Annemieke van Straten
    • 1
  • Niels Smits
    • 1
  • Filip Smit
    • 1
  1. 1.Dept. of Clinical PsychologyVrije UniversiteitAmsterdamThe Netherlands

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