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

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.