Eckshtain Dikla, Horn Rachel, Weisz John R
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114, Boston, MA, United States.
Department of Psychology, Harvard University, 1030 William James Hall, 33 Kirkland Street, 02138, Cambridge, MA, United States.
Child Psychiatry Hum Dev. 2023 Dec;54(6):1737-1748. doi: 10.1007/s10578-022-01375-y. Epub 2022 May 26.
Youth depression is an impairing pediatric condition for which psychotherapy effects are modest. Can outcomes be improved by treatments that address the family context, as proposed in practice parameters of the American Academy of Child and Adolescent Psychiatry? To find out, we searched five decades of research for randomized controlled trials testing family-based interventions; 11 trials were found for ages 4-18 years. Using robust variance estimation, we obtained estimates of effect size (ES) and tested candidate moderators that might explain variation in ES. Overall pooled ES of the studies was 0.33 at posttreatment, similar to that reported for all youth depression treatments in three prior meta-analyses (i.e., 0.36, 0.30, and 0.29), but higher for adolescents (ages ≥ 13, 0.50) than children (0.04). Taken together, our findings do not show superior outcomes for family-based interventions, and raise questions about how much confidence can be placed in the evidence base to date. The small number of relevant studies in more than five decades, together with the publication bias and risk of bias concerns, highlights the need for more trials testing family-based treatment, and for pre-registered reports, publicly-available preprints, and other mechanisms for improving the dissemination of completed research.
青少年抑郁症是一种会造成损害的儿科疾病，心理治疗对其效果甚微。按照美国儿童与青少年精神病学会实践参数的提议，针对家庭环境的治疗能否改善治疗结果？为了找到答案，我们检索了五十年来有关测试基于家庭干预措施的随机对照试验的研究；共找到11项针对4至18岁儿童的试验。我们使用稳健方差估计法，获得了效应量（ES）的估计值，并测试了可能解释效应量变化的候选调节因素。研究的总体合并效应量在治疗后为0.33，与之前三项荟萃分析中报告的所有青少年抑郁症治疗的效应量（即0.36、0.30和0.29）相似，但青少年（年龄≥13岁，0.50）的效应量高于儿童（0.04）。总体而言，我们的研究结果并未显示基于家庭的干预措施能带来更好的治疗结果，同时也引发了人们对目前证据基础可信度的质疑。五十多年来相关研究数量较少，再加上发表偏倚和偏倚风险问题，凸显了开展更多测试基于家庭治疗的试验的必要性，以及对预先注册报告、公开可用的预印本和其他改善已完成研究传播的机制的需求。
