Journal of the American Academy of Child & Adolescent Psychiatry
ARTICLESCognitive-Behavioral Therapy for Adolescent Depression: A Meta-Analytic Investigation of Changes in Effect-Size Estimates
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
REFERENCES (37)
- et al.
Group cognitive-behavioral treatment for depressed adolescent offspring of depressed parents in a health maintenance organization
J Am Acad Child Adolesc Psychiatry
(2002) - et al.
Cognitive-behavioral treatment of adolescent depression: efficacy of acute treatment and booster sessions
J Am Acad Child Adolesc Psychiatry
(1999) - et al.
Which depressed patients respond to cognitive-behavioral treatment?
J Am Acad Child Adolesc Psychiatry
(1998) - et al.
Psychosocial treatments for adolescent depression
Clin Psychol Rev
(1999) - et al.
Cognitive-behavioral treatment for depressed adolescents
Behav Ther
(1990) Depression in hospitalized child psychiatry patients: approaches to measuring depression
J Am Acad Child Adolesc Psychiatry
(1978)- et al.
Cognitive-behavioral therapy of depression and depressive symptoms during adolescence: a review and meta-analysis
J Am Acad Child Adolesc Psychiatry
(1998) - et al.
An efficacy/effectiveness study of cognitive-behavioral treatment for adolescents with comorbid major depression and conduct disorder
J Am Acad Child Adolesc Psychiatry
(2004) Publication bias and the evaluation of psychotherapy efficacy in reviews of the research literature
Clin Psychol Rev
(1996)- et al.
A randomized controlled out-patient trial of cognitive-behavioural treatment for children and adolescents with depression: 9-month follow-up
J Affect Disord
(1996)
Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III)
Improving the quality of reporting of randomized controlled trials. The CONSORT statement
JAMA
A clinical psychotherapy trial for adolescent depression comparing cognitive, family and supportive therapy
Arch Gen Psychiatry
Statistical Power Analysis for the Behavioral Sciences
Effectiveness of cognitive-behavior therapy for maladapting children: a meta-analysis
Psychol Bull
Diagnostic criteria for use in psychiatric research
Arch Gen Psychiatry
Estimation of effect size from a series of independent experiments
Psychol Bull
Statistical Methods for Meta-Analysis
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.