Authors' objectives

To determine whether cognitive behaviour therapy (CBT) approaches are effective in alleviating depression symptomatology among adolescents.

Searching

The literature was searched from 1970 to February 1997. The search involved a computerised search of medical and psychological databases, a review of references from identified studies and narrative descriptions of CBT, and a manual search of relevant journals. The authors only included psychotherapy outcome studies published in English in their analysis.

Study selection

Assessment of study quality

The authors do not state that they assessed validity.

Data extraction

The authors do not state how the data were extracted for the review, or how many of the authors performed the data extraction.

Methods of synthesis

Results of the review

Six studies with a total of 251 participants were included, although the authors stated in the abstract that the total number of participants was 217. There were 14 comparisons of post-treatment versus control, and 10 comparisons of follow-up versus control.

The heterogeneity test for the post-test data was non significant (chi-squared 14.97, d.f.=13, p=0.31), suggesting that these studies were homogeneous. The overall effect size for the post-test difference scores was significant (d -1.02; 95% confidence interval, CI: -0.81, -1.23), indicating that CBT might be effective in alleviating dysphoria and depression among adolescents.

The heterogeneity test for the follow-up data was non significant (chi-squared 12.28, d.f.=9, p=0.20), suggesting homogeneity. The overall effect size for the follow-up data was significant (d -0.61, 95% CI; -0.35, -0.88), indicating that the effects of CBT were maintained over time.

The fail-safe N-values for this study were 426 for the analysis of the post-test effects and 62 for the analysis of follow-up effects; these indicated that the findings were robust.

Authors' conclusions

CBT may be useful for reducing dysphoria among adolescents, and treatment gains are maintained over time. These conclusions are based on a limited number of studies, but the findings are robust and consistent with outcome research with depressed adults. The fail-safe N-values indicate that the effects found would not be invalidated even if a publication bias existed.

CRD commentary

A well-defined review question was presented. Sufficient detail of the individual studies was presented, and the studies were combined appropriately.

The inclusion criteria were appropriate, but the exclusion criteria were not reported. The validity of the included studies was not assessed. The authors state that by only using published psychotherapy outcome studies in the analysis,the quality of the studies reviewed is assured. However, many studies of bad quality are published and this strategy could lead to a publication bias. The authors did not state which medical and psychological databases were searched, or the search terms that were used. The authors highlighted the following limitations of the research:

1. The studies involved small sample sizes (in most of the studies there were less than 20 participants in each group).

2. There were a small number of therapists used in each treatment condition, making it difficult to ascertain whether the treatment effects are generalisable to therapists with differing styles.

3. The majority of the studies used dysphoric rather than clinically depressed adolescents.

The authors' conclusions follow from the results and useful suggestions are provided for future research.

Implications of the review for practice and research

The authors state that, in the included studies, the effectiveness of CBT was typically contrasted with a relaxation or wait-list control group. They suggest that future research should examine whether CBT is more effective than other forms of psychotherapy or medication in treating clinically depressed adolescents.

Few studies have focused on the effectiveness of specific forms of psychotherapy for addressing specific clinical concerns. The authors recommend that future studies should include detailed descriptions of the treatments being provided, and documentation of their integrity and fidelity.

The authors also suggest that future research should use objective ratings of symptom severity and raters who are blinded to the treatment condition of the participants.

Bibliographic details

Reinecke M A, Ryan N E, DuBois D L. Cognitive-behavioral therapy of depression and depressive symptoms during adolescence: a review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry 1998; 37(1): 26-34. [PubMed: 9444896]

Other publications of related interest

1. Johnson B. Software for the meta-analytic review of the research literatures. Hillsdale (NJ): Erlbaum; 1989. 2. Hedges L, Olkin I. Statistical methods for meta-analysis. San Diego (CA): Academic Press; 1985.

Indexing Status

Subject indexing assigned by NLM

MeSH

Adolescent; Adolescent Psychiatry /standards; Adult; Chi-Square Distribution; Child; Cognitive Therapy /standards; Confidence Intervals; Controlled Clinical Trials as Topic; Depression /therapy; Female; Humans; Male; Treatment Outcome

AccessionNumber

11998003371

Database entry date

30/09/1999

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.