Comparative Efficacy And Acceptability Of Psychotherapies For Depression In Children And Adolescents: A Systematic Review And Network Meta-Analysis

Previous meta-analyses of psychotherapies for child and adolescent depression were limited because of the small number of trials with directcomparisons between two treatments. A network meta-analysis, a novel approach that integrates direct and indirect evidence from randomizedcontrolled studies, was undertaken to investigate the comparative efficacy and acceptability of psychotherapies for depression in childrenand adolescents. Systematic searches resulted in 52 studies (total N53805) of nine psychotherapies and four control conditions. Weassessed the efficacy at post-treatment and at follow-up, as well as the acceptability (all-cause discontinuation) of psychotherapies and controlconditions. At post-treatment, only interpersonal therapy (IPT) and cognitive-behavioral therapy (CBT) were significantly more effectivethan most control conditions (standardized mean differences, SMDs ranged from -0.47 to -0.96). Also, IPT and CBT were more beneficialthan play therapy. Only psychodynamic therapy and play therapy were not significantly superior to waitlist. At follow-up, IPT and CBT weresignificantly more effective than most control conditions (SMDs ranged from -0.26 to -1.05), although only IPT retained this superiority atboth short-term and long-term follow-up. In addition, IPT and CBT were more beneficial than problem-solving therapy. Waitlist was significantlyinferior to other control conditions. With regard to acceptability, IPT and problem-solving therapy had significantly fewer all-causediscontinuations than cognitive therapy and CBT (ORs ranged from 0.06 to 0.33). These data suggest that IPT and CBT should be consideredas the best available psychotherapies for depression in children and adolescents. However, several alternative psychotherapies areunderstudied in this age group. Waitlist may inflate the effect of psychotherapies, so that psychological placebo or treatment-as-usual maybe preferable as a control condition in psychotherapy trials.