Massachusetts General Hospital, Harvard Medical School, Boston.
KU Leuven, Belgium, and Karel de Grote University College, Antwerp, Belgium.
J Am Acad Child Adolesc Psychiatry. 2020 Jan;59(1):45-63. doi: 10.1016/j.jaac.2019.04.002. Epub 2019 Apr 17.
Youth depression is a debilitating condition that constitutes a major public health concern. A 2006 meta-analysis found modest benefits for psychotherapy versus control. Has 13 more years of research improved that picture? We sought to find out.
We searched PubMed, PsychINFO, and Dissertation Abstracts International for 1960 to 2017, identifying 655 randomized, English-language psychotherapy trials for individuals aged 4 to 18 years. Of these, 55 assessed psychotherapy versus control for youth depression with outcome measures administered to both treatment and control conditions at post (κ = 53) and/or follow-up (κ = 32). Twelve study and outcome characteristics were extracted, and effect sizes were calculated for all psychotherapy versus control comparisons. Using a three-level random-effects model, we obtained an overall estimate of the psychotherapy versus control difference while accounting for the dependency among effect sizes. We then fitted a three-level mixed-effects model to identify moderators that might explain variation in effect size within and between studies.
The overall effect size (g) was 0.36 at posttreatment and 0.21 at follow-up (averaging 42 weeks after posttreatment). Three moderator effects were identified: effects were significantly larger for interpersonal therapy than for cognitive behavioral therapy, for youth self-reported outcomes than parent-reports, and for comparisons with inactive control conditions (eg, waitlist) than active controls (eg, usual care). Effects showed specificity, with significantly smaller effects for anxiety and externalizing behavior outcomes than for depression measures.
Youth depression psychotherapy effects are modest, with no significant change over the past 13 years. The findings highlight the need for treatment development and research to improve both immediate and longer-term benefits.
青少年抑郁症是一种使人虚弱的疾病，是一个主要的公共卫生关注点。2006 年的一项荟萃分析发现，心理疗法对比对照组有适度的益处。13 年的研究进展是否改善了这一状况？我们试图找到答案。
我们在 PubMed、PsychINFO 和 Dissertation Abstracts International 中检索了 1960 年至 2017 年的文献，共识别出 655 项针对 4 至 18 岁个体的随机、英语语言心理疗法试验。其中，55 项评估了心理疗法对比对照组对青少年抑郁症的疗效，在治疗后(post)（κ=53）和/或随访(follow-up)（κ=32）时对治疗组和对照组都进行了结局测量。提取了 12 项研究和结局特征，并计算了所有心理疗法对比对照组的效应量。我们使用三级随机效应模型，在考虑效应量相关性的情况下，获得了心理疗法对比对照组差异的总体估计值。然后，我们拟合了一个三级混合效应模型，以确定可能解释研究内和研究间效应量变异的调节因素。
治疗后(post)的总体效应量(g)为 0.36，随访时(follow-up)为 0.21（平均在 posttreatment 后 42 周）。确定了 3 个调节因素效应：人际心理疗法的效应明显大于认知行为疗法，青少年自我报告的结局优于父母报告的结局，以及与非活动对照组（如等待名单）相比，与活动对照组（如常规护理）相比的效应更大。效应具有特异性，与抑郁测量相比，焦虑和外化行为结局的效应较小。
青少年抑郁症心理疗法的疗效适度，在过去 13 年中没有显著变化。研究结果强调需要开发和研究治疗方法，以提高即时和长期获益。
