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In Brief: Treating depressed children: Limits of psychotherapy

In Brief

Treating depressed children: Limits of psychotherapy

The largest pooled analysis of controlled studies so far has found that psychotherapy for childhood depression is only moderately and often temporarily successful, and that cognitive therapy is not more effective than other approaches.

The authors believe they have improved on previous meta-analyses that came to more optimistic conclusions. They included more clinical trials, 35 all together. They contacted investigators repeatedly and persuaded them to provide more information. And they say their statistical techniques were more accurate.

On average, psychotherapy had moderate effects immediately after treatment on both depression and anxiety, but not on "externalizing" behavior problems like attention deficit disorder and conduct disorder. About half of the studies included follow-ups, which suggested that differences resulting from psychotherapy persisted for a while but disappeared after a year. It did not matter whether the treatment was group or individual therapy, whether patients were recruited from advertisements or referred by a clinician, whether therapy took place in a clinical or a research setting. The time devoted to a child (more or less than 12 hours of psychotherapy) and the child's age did not influence the outcome either. Cognitive therapy, which stresses the correction of self-defeating and unrealistic thoughts, was not superior to interpersonal therapy (concentrating on personal relationships and life transitions) or to purely behavioral methods like social skills training and behavioral family therapy.

Psychotherapy was equally effective whether it was compared to a waiting list or to an "active control" providing the same amount of attention — often something like supportive listening.

What did make a difference? The active treatments were more successful than control conditions when judged by the children themselves, but not when judged by their parents. And the lower the proportion of boys in a given study, the greater the effect of psychotherapy.

For future research, the authors recommend longer follow-up (only five studies stayed with patients for more than a year), more intent-to-treat analysis (that is, factoring in dropouts), and more attention to specific processes of change as opposed to results alone.

Weisz JR, et al. "Effects of Psychotherapy for Depression in Children and Adolescents: A Meta-Analysis," Psychological Bulletin (January 2006): Vol. 132, No. 1, pp. 132–49.

Last updated:	September 05, 2008