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Systemic therapy for children and adolescents with depression: a systematic review and meta-analysis

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Abstract

This systematic review and meta-analysis aimed to investigate the efficacy and acceptability of systemic therapy in treatment of children and adolescents with depression. Six databases were used to identify randomized controlled trials (RCTs) applying systemic therapy (ST). Random-effects meta-analyses were conducted to estimate efficacy and acceptability of intervention. The primary outcome of efficacy was defined as changes of depressive symptoms. Secondary outcomes of efficacy included response rate and function improvement. Nine RCTs (n = 640) were included. For the immediate efficacy of depressive symptoms, ST was superior to waiting-list (WL) (n = 117, SMD -1.75, 95% CI -2.96 to -0.54), similar to treat as usual (TAU) (n = 146, SMD -0.45, 95% CI -1.14 to 0.24) or supportive psychotherapy (n = 263, SMD -0.04, 95%CI -0.28 to 0.20), superior to psychodynamic psychotherapy (n = 72, SMD -0.66, 95%CI -1.13 to -0.18) and inferior to cognitive behavior therapy (CBT) (n = 72, SMD 0.58, 95%CI 0.11 to 1.05). About response rate, ST (47.7%) was superior to WL, similar to TAU and supportive therapy and dynamic psychotherapy, and inferior to CBT. ST was comparable to CBT, supportive therapy and dynamic therapy on function improvement (SMD 0.18, 95% CI -0.12 to 0.49). As for acceptability, no significant difference was found between ST (11.9%) and controls (OR 0.97, 95%CI 0.61 to 1.56). In treating youths with depression, ST was superior to WL, similar to supportive psychotherapy and TAU, inferior to CBT, similar or superior to dynamic psychotherapy on symptoms relief. ST demonstrated comparable acceptability to TAU and guideline-recommended psychotherapies. Considering small sample size, the conclusion should be treated cautiously.

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The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

The study was supported by grants from the Beijing Municipal Science and Technology Commission (Z191100006619047).

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  1. Ying Huang and Yujing Li contributed equally to this work.

Authors and Affiliations

  1. Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Beijing, 100144, China

    Ying Huang

  2. Department of Ophthalmology & Clinical Center of Optometry, Peking University People’s Hospital, Beijing, 100044, China

    Yujing Li

  3. Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany

    Markus W. Haun

  4. Clinical Psychological Center of Peking University Sixth Hospital, National Clinical Research Center for Mental Disorders and NHC Key Laboratory of Mental Health (Peking University Sixth Hospital), 51 HuayuanBei Road, Haidian District, Beijing, 100191, China

    Rao Xie, Li Yang & Ying Qian

  5. Helm Stierlin Institute, 29, Wolfsbrunnenweg Castle, 69118, Heidelberg, Germany

    Rüdiger Retzlaff

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Contributions

Ying Huang contributed to the design of study, trial searching, trial selection, risk of bias assessments, data extraction, quantitative and qualitative analyses, writing, and typing of the article. Yujing Li contributed to designing the study, trial searching, trial selecting, risk of bias assessments, data extraction, analyses, and writing. Ying Huang and Yujing Li finished the interpretation of results and manuscript writing. Yujing Li drafted the tables in article. Ying Huang typed the manuscript. Ying Huang and Yujing Li contributed equally to this work. Markus W. Haun contributed to the manuscript editing and provided critical suggestions. Rao Xie contributed to the design of study and data processing. Li Yang provided pivotal suggestions about study design and interpretation of results. Ying Qian contributed to the design of study and provided key advise for interpretating results. Rüdiger Retzlaff and Ying Qian revised the protocol and manuscript critically for important intellectual content. All authors have read and approved the final manuscript.

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Huang, Y., Li, Y., Haun, M.W. et al. Systemic therapy for children and adolescents with depression: a systematic review and meta-analysis. Curr Psychol 43, 3355–3367 (2024). https://doi.org/10.1007/s12144-023-04558-5

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