ARTICLES
Cognitive-Behavioral Therapy for Adolescent Depression: A Meta-Analytic Investigation of Changes in Effect-Size Estimates

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ABSTRACT

Objective

To explicate differences between early and recent meta-analytic estimates of the effects of cognitive-behavioral therapy (CBT) for adolescent depression.

Method

Meta-analytic procedures were used to investigate whether methodological characteristics moderated mean effect sizes among 11 randomized, controlled trials of CBT focusing on adolescents meeting diagnostic criteria for unipolar depression.

Results

Cumulative meta-analyses indicated that effects of CBT have decreased from large effects in early trials, and confidence intervals have become narrower. Effect sizes were significantly smaller among studies that used intent-to-treat analytic strategies, compared CBT to active treatments, were conducted in clinical settings, and featured greater methodological rigor based on CONSORT (Consolidated Standards of Reporting Trials) criteria. The mean posttreatment effect size of 0.53 was statistically significant.

Conclusions

Differences in estimates of the efficacy of CBT for depressed adolescents may stem from methodological differences between early and more recent investigations. Overall, results support the effectiveness of CBT for the treatment of adolescent depression.

Section snippets

Literature Review

The literature search spanned the period January 1980 to September 2006. Studies were located via searches of medical and psychological databases (PsychINFO, Medline, 1966-2006) and a review of references from identified outcome studies of CBT. Key words used in the searches included “depression,” “dysthymia,” and “major depression,” with searches limited to youth populations. Following inclusion criteria used in several similar meta-analyses (Reinecke et al., 1998, Weisz et al., 1995a), we

RESULTS

From 11 RCTs, 11 posttreatment and 9 follow-up control comparisons incorporated data from 809 and 638 participants, respectively. Populations studied included students, outpatients, children of outpatients, and youths in the juvenile justice system. Across studies, mean ages ranged from 12.7 to 16.2 years, and treatment involved 17.60 hours of therapy on average. Treatment with CBT was compared to a variety of control conditions including waitlists, conditions controlling for nonspecific

DISCUSSION

In the present investigation, we attempted to identify reasons for the reduced effects of CBT for adolescent depression in recent trials relative to large effects in early RCTs. In contrast to recent meta-analyses (Weisz et al., 2006), which included studies of youths with varying degrees of depressive symptomatology, we focused exclusively on RCTs involving adolescents with depressive diagnoses. Iterative cumulative meta-analyses involving 11 RCTs showed that the effects of CBT have declined

CONCLUSIONS

Differences in methodological characteristics between early and recent RCTs may contribute to discrepancies among estimates of the effects of CBT for adolescent depression. These differences appear to reflect both a shift from an initial emphasis on demonstrating the efficacy of treatment in controlled research settings to an emphasis on demonstrating the effectiveness of treatment and the application of increased statistical and methodological rigor over time. Taken together, the results

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  • Cited by (0)

    Reviewed under and accepted by Michael S. Jellinek, M.D.

    Research supported by NIMH fellowship (F31MH075308) to Rachel Jacobs. The authors express their gratitude to Larry Hedges, Ph.D., for his generosity in providing guidance and assistance in the preparation of this manuscript. They also thank Paul Rohde, Ph.D., John Weisz, Ph.D., and Richard Zinbarg, Ph.D., for their insightful comments on an early draft of this report.

    Disclosure: The authors have no financial relationships to disclose.

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