CRD summary

The authors concluded that the evidence base was insufficient, but cCBT held potential as an acceptable and clinically effective intervention for depression and anxiety in children and adolescents. Further research was recommended. The tentative conclusion is appropriate, but constraints in the search and unclear study quality made the reliability of this conclusion unclear.

Authors' objectives

To evaluate the effectiveness of computerised cognitive-behavioural therapy (cCBT) interventions for prevention and treatment of depression and anxiety in children and adolescents.

Searching

PubMed, EMBASE and PsycINFO were searched for studies in English published or in press in peer-reviewed journals between 1980 and 2008. Search terms were reported. Reference lists of included papers were scanned and authors were contacted to identify further studies.

Study selection

Studies of cCBT interventions to prevent and treat depression and/or anxiety and that included some children and adolescents under 18 years were eligible for inclusion.

The age of included participants ranged from seven to 25 years. Their conditions varied from high risk of depression to diagnosed illness. A range of anxiety disorders were included. Interventions and the level and nature of professional contact contained within each varied. Most interventions (including six different software packages) were interactive and multimedia, including psychoeducation, exercises and quizzes, homework assignments, case vignettes, narration, cartoons and videos. The number of sessions ranged from five to 14. Individual sessions or modules lasted from 15 to 90 minutes or 143 minutes overall for the modular intervention. Some interventions included sessions for parents. All depression interventions programmes were directed only at the child. The primary child-, parent- or clinician-reported outcomes included changes in primary diagnosis or severity, number of comorbid diagnoses, anxiety and depressive symptoms, global functioning and behaviour. Other outcomes that included participant satisfaction with the interventions were reported.

Two independent reviewers selected studies for inclusion. Disagreements were resolved by consensus.

Assessment of study quality

The authors did not report any formal validity assessment of the included studies.

Data extraction

Data were extracted on the main findings as reported by included studies. These included direction of effect and proportions of participants who achieved the various outcomes.

Two reviewers carried out the data extraction.

Methods of synthesis

A narrative synthesis was presented. Differences between studies could be viewed in the tables and text.

Results of the review

Ten studies were included in the review. Six studies addressed depression. Four studies addressed anxiety. There were six randomised controlled trials (RCTs) (n=464 participants), two case series with pre- and post-intervention comparisons (n=212) and two case series (n=5, n=2). Follow-up data at 12 weeks was provided in one RCT. Attrition ranged from 33% to 70%.

All studies reported improvements on a variety of outcomes. One RCT showed that improvements in depressive symptoms were achieved only after at least three sessions. Percentages of participants who did not fulfil criteria for their primary diagnosis ranged from 30% to 78%. Other improved outcomes were reported in the areas of strengths and difficulties, cognitions, style of attribution, self-esteem, automatic thoughts, hopelessness, thoughts about self harm and negative affect. Four studies (two RCTs) suggested that improvements continued over time. Compared to the control group, one RCT demonstrated a significantly improved effect on depression and two RCTs significantly improved outcomes related to anxiety and global functioning. Satisfaction with interventions was moderate to high (four studies).

Authors' conclusions

The evidence base was insufficient, but cCBT held potential as an acceptable and clinically effective intervention for depression and anxiety in children and adolescents.

CRD commentary

The review question was clear. Inclusion criteria were broad and consequently attracted wide variation among the included studies. The search strategy included relevant sources. The limitation to articles published in English may mean that relevant studies were missed and associated biases could not be ruled out. Study characteristics were presented in detail, but the absence of any formal validity assessment made the reliability of the included studies unclear. The processes of study selection and data extraction were carried out with efforts to minimise error and bias. The chosen method of synthesis was appropriate given the wide variation in study characteristics.

The authors' tentative conclusion reflects the limited evidence presented, but search constraints and unclear study quality made the reliability of this conclusion unclear.

Implications of the review for practice and research

Practice: The authors stated that clinicians needed to consider the potential for cCBT in children and adolescents to be incorporated into practice.

Research: The authors stated a need for randomised controlled trials, particularly to compare cCBT against face-to-face cCBT. Longer term follow-up and exploration of influences connected to participant characteristics, session content and delivery, acceptability of the intervention and cost-effectiveness were needed.

Funding

Research for Patient Benefit grant.

Bibliographic details

Richardson T, Stallard P, Velleman S. Computerised cognitive behavioural therapy for the prevention and treatment of depression and anxiety in children and adolescents: a systematic review. Clinical Child and Family Psychology Review 2010; 13(3): 275-290. [PubMed: 20532980]

Original Paper URL

http://www.springerlink.com/content/23570436r2m76302/

Indexing Status

Subject indexing assigned by NLM

MeSH

Adolescent; Anxiety Disorders /prevention & control /psychology /therapy; Child; Cognitive Therapy /methods; Depressive Disorder /prevention & control /psychology /therapy; Humans; Patient Acceptance of Health Care /psychology; Patient Dropouts /psychology; Patient Satisfaction; Professional-Patient Relations; Randomized Controlled Trials as Topic; Self Concept; Software; Therapy, Computer-Assisted /methods

AccessionNumber

12011000244

Database entry date

05/10/2011

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.