Effectiveness of Psychological Treatments For Depression in Childhood and Adolescence: A Review of Reviews

Revista de Psicología Clínica con Niños y Adolescentes Copyright© 2023 RPCNA
Vol. 10 nº. 1- Enero 2023 - pp 68-83 www.revistapcna.com - ISSN 2340-8340

doi: 10.21134/rpcna.2023.10.1.6
Revista de Psicología Clínica con Niños y Adolescentes
Effectiveness of psychological treatments for

depression in childhood and adolescence: A
review of reviews
José P. Espada, Alejandra Sánchez-López, & Alexandra Morales
AITANA Research Group, Miguel Hernández University, Spain
Abstract
Depression in childhood and adolescence is a public health problem due to its high prevalence and the impact it has in the individual develop-
ment. There is clear evidence of the efficacy of Interpersonal Therapy (IPT) and Cognitive-Behavioural Therapy (CBT) in the treatment of depres-
sion in children and adolescents; however, recent reviews and meta-analyses provide new perspectives for treatment. The purpose of this work
is to synthesize the bibliography available through a systematic review of systematic reviews and meta-analysis that summarizes in a compre-
hensive way the evidence of the last two decades on the effectiveness of psychological interventions for infant-juvenile depression. A systematic
review of systematic reviews and meta-analyses was performed. A search was conducted in the Web of Science and Scopus databases. Eight
records met the inclusion criteria, 2 were analysed in their entirety and from the remaining 6 the information needed for independent analysis was
extracted. Seven different psychotherapies were studied: CBT and IPT were the most studied (n=7; 87.5%), followed by family therapy (n=5;
62.5%), psychodynamic therapy (n=3; 37.5%), behavioural therapy (n=3; 37.5%), computerised CBT (n=2; 25%), problem-solving therapy (n=1;
12.5%) and supportive therapy (n=1; 12.5%). IPT and CBT were shown to be effective in the treatment of adolescent depression. Half of the
reviews (n=4; 50%) had a low methodological quality and the other half (n=4; 50%) were classified as critically low. In general, psychological
interventions for child and adolescent depression produce significant, but modest effects. Specifically, IPT and CBT can be considered the main
treatment alternatives for adolescent depression. There is insufficient data of specific psychological treatment for children diagnosed with a de-
pressive disorder. It is suggested that research should be increased to improve the methodological quality and increase the number of studies
aimed at the children population.
Keywords: umbrella review; psychological treatments; psychotherapy; depression; childhood; adolescence.
Resumen
Eficacia de los tratamientos psicológicos para depresión en la infancia y la adolescencia: Una revisión de revisiones. La depresión infanto-ju-
venil es un problema de salud pública por su elevada prevalencia y el impacto que tiene en el desarrollo del individuo. Aunque existe una sólida
evidencia sobre la eficacia de la psicoterapia interpersonal y la terapia cognitivo-conductual (TCC) en el tratamiento de la depresión en niños y
adolescentes, recientes revisiones y meta-análisis aportan nuevas perspectivas de tratamiento. La finalidad de este trabajo es sintetizar la biblio-
grafía disponible mediante una revisión sistemática de revisiones sistemáticas y meta-análisis que resuma de manera integral la evidencia de las
últimas dos décadas sobre la eficacia de las intervenciones psicológicas para la depresión infanto-juvenil. Se realizó una revisión sistemática de
revisiones sistemáticas y meta-análisis. Se llevó a cabo una búsqueda en las bases de datos Web of Science y Scopus. Ocho registros cumpli-
eron los criterios de inclusión, 2 se analizaron en su totalidad y de los 6 restantes se extrajo la información necesaria para ser analizada indepen-
dientemente. Se estudiaron siete psicoterapias distintas: la TCC y la terapia interpersonal fueron las más estudiadas (n=7; 87,5%), seguidas por
la terapia familiar (n=5; 62,5%), la terapia psicodinámica (n=3; 37,5%), la terapia conductual (n=3; 37,5%), la TCC informatizada (n=2; 25%), la
terapia de resolución de problemas (n=1; 12,5%) y la terapia de apoyo (n=1; 12,5%). La terapia interpersonal y la TCC demostraron ser efec-
tivas en el tratamiento de la depresión adolescente. La mitad de las revisiones (n=4; 50%) presentaron una calidad metodológica baja y la otra
mitad (n=4; 50%) se clasificó como críticamente baja. Las intervenciones psicológicas para la depresión infanto-juvenil, en general, producen
efectos significativos, pero modestos. De forma específica, la terapia interpersonal y la TCC pueden considerarse las principales alternativas de
tratamiento para la depresión adolescente. No se dispone de datos suficientes sobre el tratamiento psicológico específico para niños con un
Corresponding author:
Jose P. Espada
Universidad Miguel Hernández, AITANA Research Group. Department of Health Psychology.
Av. de la Universidad, s/n. 03202. Elche (Alicante), Spain
E-mail: jpespada@umh.es
Effectiveness of psychological treatments for depression in childhood and adolescence: A review of reviews
José P. Espada, Alejandra Sánchez-López, & Alexandra Morales 69
diagnóstico de un trastorno depresivo. Se sugiere un aumento de la investigación que mejore la calidad metodológica y aumenten los estudios
dirigidos a la población infantil.
Palabras clave: revisión de revisión; meta-revisión; tratamientos psicológicos; psicoterapia; depresión; infancia; adolescencia.
Depression is a major public health problem, currently one of the In the last decade there has been a substantial increase in the num-
leading causes of illness and disability in adolescents (World Health ber of umbrella reviews published, understood as systematic reviews
Organization [WHO], 2021a). The presence of depression during ado- of systematic reviews and meta-analyses, and which represent one of
lescence acts as a risk factor for developing another depressive episode, the highest levels of evidence synthesis currently available (Fusar-Poli
as happens in 60-70% of cases (Birmaher et al., 1996; Kovacs et al., 1984). & Radua, 2018). Thus, umbrella reviews have been published aimed to
However, in most cases, childhood and adolescent depression is not addressing various issues about the treatment of depression in child-
detected or treated due to its atypical manifestation and high comorbid- hood and adolescence, such as those of Trujillo-Franco and Martín-
ity (Flament et al., 2011; WHO, 2021b). ez-Martínez (2021) and Wegner et al. (2020), evaluating the effects
Depression during childhood and adolescence has a great impact on of physical exercise on infant-juvenile depression, that of Crowe and
the social and personal development, being associated with a decrease in McKay (2017), which focuses on the effectiveness of CBT or, more
academic performance, a deterioration in social functioning, problems generally, those of Correll et al. (2021) and Cortese et al. (2018) which
in the relationship with family members and peer groups, and with an analyse the effectiveness of pharmacological and psychosocial inter-
increased risk of self-harm and suicidal ideas and behaviours (Birmaher ventions in children and adolescents with different psychopathologies,
et al., 1996; Weissman, 1999) at a time when suicide represents the third including depression. However, there are methodological variations
cause of death between 15 and 19 years in Spain (Instituto Nacional de and limitations between these reviews that make it difficult to general-
Estadística [INE], 2020) and the fourth in the world (WHO, 2021b). ize the results, since, for example, some of them admitted the presence
There is a high comorbidity in infant-juvenile depression, espe- of symptoms of depression with any degree of severity, diagnosis is
cially with anxiety disorders, behavioural and opposition disorders not necessary (Trujillo-Franco & Martínez-Martínez, 2021), or they
and with attention deficit hyperactivity disorder (ADHD) (Angold & included systematic reviews or meta-analyses accepted studies with
Costello, 1993). Although similar criteria are used for the diagnosis any type of design (such as quasi-experimental studies or non-ran-
of depression among youth and adults, children and adolescents pres- domized controlled trials) (Trujillo-Franco & Martínez-Martínez,
ent more somatic symptoms, such as headache or stomach pain, and 2021; Wegner et al., 2020). Although, while it is true that the rest of
irritability and boredom stand out as the predominant mood symp- the reviews follow a similar methodology (they only include system-
toms, unlike adults, who report higher levels of sadness (Flament et al., atic reviews and meta-analyses of randomized controlled trials (RCT)
2011), which can make identification difficult. that address the treatment of children and adolescents with a diagno-
In a meta-analytical review, Erskine et al. (2017) found an overall sis of depression), only focus on a specific type of treatment (Crowe &
mean prevalence of depression of 6,2% in children and adolescents McKay, 2017) or do not exclusively address psychotherapy, including
between 5 and 17 years. This is corroborated by data from the Costello a large number of studies that focus just on the effect of antidepres-
et al. (2006) study, which found depression prevalence rates of 2.8% for sants on pediatric depression (Correll et al., 2021; Cortese et al., 2018).
children under 13 and 5.6% for adolescents between 13 and 18. Taking into account all these issues, and since no review of
Given the high prevalence and impact of depressive disorders, reviews of the efficacy of psychotherapy for the treatment of depres-
multiple clinical practice guidelines have been published to provide sion in children and adolescents has been found following a review of
reliable recommendations for addressing childhood depression, such the existing literature, the present umbrella review aims to: a) compre-
us the guideline of the National Institute for Health and Care Excel- hensively summarize the evidence of the last two decades on the effec-
lence (NICE, 2019), which proposes psychotherapy as a first-line treat- tiveness of psychosocial interventions for infant-juvenile depression;
ment before considering pharmacological interventions in children b) facilitate access to existing evidence; c) provide a framework for
and adolescents between 5 and 18 years old who present mild or mod- guidance to mental health professionals and researchers; and d) help
erate-severe depression. identify gaps and limitations in the present area of study in order to
There are several systematic reviews and meta-analyses that eval- guide future research. With these objectives, this work aims to provide
uate the efficacy of treatments for infant-juvenile depression, find- data on the scientific evidence about the effectiveness of psychological
ing strong evidence for interpersonal psychotherapy (IPT) (adapted interventions for the treatment of depression in children and adoles-
for adolescents) and cognitive-behavioural therapy (CBT) (Zhou cents, and explore the advances in research on the efficacy of treat-
et al., 2015), which can be considered well-established treatments for ments for depressed children and adolescents in the last two decades.
depression in adolescents (11-18) following the evidence criteria of
the American Psychological Association (APA), while CBT may be Method
considered a possibly efficacious treatment for depression in children
(5-11) (Weersing et al., 2017). This systematic review of systematic reviews and meta-analyses was
Recent studies bring new perspectives to the treatment of depres- performed following Preferred Reporting Items for Systematic Reviews
sion in children, such as the meta-analysis of Zhou et al. (2020), and Meta-Analyses (PRISMA) (Page et al., 2020). This umbrella was also
which includes studies from 1986 to 2018, or the review of Méndez registered at PROSPERO (CRD42022360071) on September 13, 2022.
et al. (2021), which considers different treatment modalities, such as
computerised CBT or family therapy, so it is essential to synthesize Eligibility criteria
information on the evidence available for recent interventions, as it
would allow greater and easier access to updates and help identify areas To determine which revisions and meta-analyses were appropriate
requiring further study and deepening. for the present umbrella, these had to meet criteria that were established
70 Tratamientos psicológicos para depresión
following the 5 categories proposed by the PICOS method (Methley et Publications focusing exclusively on prevention and those eval-
al., 2014). The following inclusion criteria were therefore defined: uating the effectiveness of transdiagnostic treatments were also
a)Population excluded. Reviews that analysed the efficacy of pharmacological treat-
Age: Children and adolescents up to 19 years, following the age ments (also compared and combined with psychotherapy) or other
classification proposed by the WHO (2002). In addition, because there interventions from a perspective other than psychology (e.g., pseu-
is no consensus regarding the definition of the stages of the life cycle, it do-therapies or sport) were discarded and those that did not provide
was agreed that, in case of finding reviews where the author identified sufficient data on any of the previously named inclusion criteria.
adolescence in an age range >19, these would be included as long as Considering the high comorbidity in infantile-juvenile depres-
the mean was <19, following the criteria already established by other sion, no restrictions were established, and it was only agreed to
studies and reviews, such as Weisz et al. (2006) and Zhou et al. (2020). exclude reviews that included samples with developmental problems
Diagnosis: Participants should present a primary diagnosis of a or deficits in cognitive functioning, such as autism, as they could
depressive disorder, including major depressive disorder, dysthymia affect the response to treatment.
and other specified types, diagnosed according to a clinical interview, Finally, due to the difficulty of finding studies aimed at the popu-
based on the criteria proposed by the Diagnostic and Statistical Man- lation of interest that met all the inclusion criteria, it was determined
ual of Mental Disorders (DSM), the International Classification of that those systematic reviews and meta-analyses that provide sepa-
Diseases (ICD) or others, in any of its versions, or according to any of rate information on the outcome of interventions for infant-juvenile
the validated scales and standardized measures. depression according to pre-established criteria.
It was also established that studies on psychotic, chronic and/or
refractory depression could be included because, despite the special Search strategy
conditions of these depressive disorders, patients in these studies
meet the criteria for depression (Jobst et al., 2016). In order to identify eligible publications, a comprehensive search
b)Intervention strategy was developed using keywords, which were combined to locate
The included studies should evaluate the effectiveness of psycho- all relevant reviews from the last two decades examining the effects of
logical interventions in the treatment of childhood and adolescent psychotherapy on the treatment of infant-juvenile depression.
depression, defined as any type of psychotherapy, in any of its modal- The search was carried out mainly in the two large databases Web
ities (individual, group, online). of Science and Scopus, and the terms used were: (“depression” OR
c)Comparator “depressed” OR “mood disorder”) AND (“children” OR “adolescen*”
For a wider scope of this umbrella, it was decided to include reviews OR “teenagers”) AND (“treatment” OR “psychointervention” OR
comparing the effects between different types of psychotherapy and/or “psycho-intervention” OR “intervention*” OR “psychotherapy” OR
a control group, that is, no restrictions were established with respect “psycho-therapy” OR “therapy” OR “counsel*”) AND (“systematic
to the comparator, allowing any type of comparison, whether active or review” OR “literature review” OR “meta-analysis” OR “metaanaly-
passive control: waiting list, no treatment, treatment as usual, placebo, sis”) alternating the booleans AND and OR in order to obtain as many
other intervention or any other method of comparison. combinations as possible. Similarly, reference lists of retrieved articles
d)Outcome were reviewed and examined to identify other possible revisions not
The outcome variable that was considered was the efficacy of psy- collected during the database search.
chotherapy in post-treatment, understood as the impact of the interven-
tion on infant-juvenile depression, more specifically as the reduction of Study selection
depressive symptoms, measure by any method providing qualitative or
quantitative information, such as structured clinical interviews, validated An Excel file was developed to export all results and duplicates
measurements, standardized screening questionnaires such as Children’s were removed using Mendeley software. After this process, the arti-
Depression Inventory (CDI; Kovacs, 1985), self-reported improvement cles were analysed and selected by two authors (ASL and JPE), who
and/or effect size in case meta-analyses report this information. followed the inclusion and exclusion criteria previously established.
e)Study Design To do this, ASL conducted a first screening based on the title and
Systematic reviews or meta-analyses that include only rand- abstracts, and then ASL and JPE examined the full text of those revi-
omized controlled trials (RCT) (including cluster RCTs and cross- sions to select those articles that were finally included in this study.
over RCTs), in order to minimize the risk of bias, as RCTs, due to ASL examined the reviews and JPE verified the decisions. Disagree-
their characteristics, make it possible to determine more accurately ments were resolved through discussion and consultation with an
the existence of cause-effect between the intervention and the results independent third reviewer (AMS).
(Sibbald & Roland, 1998).
In addition, no geographical limitations were established, but the Data extraction
revisions should be available in English or Spanish and should have
been published from 2001 to February 2022. Two tables were developed for data extraction to collect and syn-
Therefore, for exclusion criteria, systematic reviews or meta-anal- thesize in a structured format all the relevant information of the revi-
yses were excluded if they included studies other than RCTs (qua- sions and meta-analyses included in the work. Once again, ASL and
si-experimental studies or open trials), whose participants were >19 JPE were responsible for this task. ASL extracted the data, JPE verified
years old or whose sample had another main diagnosis (such as an the extracted data and disagreements were resolved through discus-
anxiety disorder), did not have a diagnosis of a depressive disorder sion with a third author (AMS).
or had depressed symptoms, as well as eliminating those reviews that Thus, the data extracted in the first table were: a) first author and
included psychotherapy applied only to the parents of minors, that is, year of publication, b) aims, c) search strategy, d) type and number
interventions aimed at training parents. of studies included, e) participants’ characteristics (total number of
participants, age range and mean, diagnosis of the sample and, if pro- out a first screening, after which 2,890 publications were excluded.
vided, country/nationality), f) intervention’s characteristics (type of A selection of 142 potentially relevant records were reviewed in full
psychotherapy, delivery format (individual or group) and duration), text, carrying out the second and last screening. Finally, after their
g) professionals providing the intervention, h) outcome measures and evaluation, 8 studies met the eligibility criteria and were included in
i) funding sources for the review. the present umbrella. The remaining 134 were excluded for different
The second table collected the following information: a) first reasons, which are indicated in the flowchart PRISMA (2020), where
author and year of publication, b) risk of bias, c) main findings and d) the entire selection process is collected.
effect estimates (if a meta-analysis was performed).
Study Characteristics
Assessment of quality and risk of bias
The information on the general characteristics of the systematic
In order to assess the methodological quality and risk of bias of reviews and the meta-analyses included is summarized in Table 1.
the systematic reviews and meta-analyses included, two independent The eight revisions were published between 2006 and 2021. Two
authors, ASL and JPE, used AMSTAR-2, a tool composed of 16 items of them met all the inclusion criteria and were analysed in their
that allows the critical evaluation of the quality of systematic reviews entirety, while of the remaining six the information relevant to the
that include RCTs, not RCTs or both and provides a global quality rat- present study object was analysed. This was mainly due to the fact that
ing (Shea et al., 2017). In case of disagreement, consensus was reached most of the studies used samples that included depressive symptoms
through discussion. together with participants who presented a diagnosis of a depressive
disorder, but performed an independent analysis of the data.
Results Therefore, the results of 124 studies were analysed in this
review of reviews, all of them randomized controlled tri-
Identification and selection of studies als (RCTs). The number of participants included was 6,952,
although the revisions of Cuijpers et al. (2020) and Cuijpers et
In the initial bibliographic search, 3,492 publications were iden- al. (2021) did not provide information. Participants ranged in
tified and 37 additional records were incorporated after the revision age from 3 to 19 years. All studies included a variety of diagno-
of references. The duplicates were then eliminated and a total of 3,032 ses of depressive disorders, highlighting the diagnosis of major
records were examined on the basis of their title and abstract, carrying depressive disorder, dysthymia, resistant depression, the diag-
Figure 1. PRISMA Flowchart (2020).
Identification of studies via databases and registers
Records or citations identified from:

Scopus (n = 2,044).
Web of Science (n = 1,348).
Total (n = 3,492).
Identification
Records or citations identified

from other sources:
Citation search (n = 37).
Records or citations deleted
before screening:
Duplicate records or citations
(n = 397).
Screened records (n = 3,032). Registrations excluded on the basis of title and abstract
(n = 2,890).
Screening
Excluded publications (n = 134):

Publications assessed for
eligibility (n = 142).
- Not meet diagnostic criteria or high symptomatology
(n = 49).
- Not RCTs (n = 31).
- Prevention intervention (n = 13).
- No depresión foco de intervención
(n = 12).
Included
- Not a systematic review or a meta-analysis (n = 7).

Total reviews included in the
- Include combined or comparative pharmacology (n
Umbrella (n = 8).
= 6).
- Inadequate age range (mean >19)
(n = 5).
- Do not report sufficient data (n = 5).
- Not accessible in English or Spanish (n = 3).
- Do not include psychotherapeutic treatment (n = 2).
- Include comorbidity with cognitive deficits (n = 1).
Note: n= number of studies; RCT= Randomized Controlled Trial.

nosis of a depressive disorder not otherwise specified, minor al., 2020), followed by family therapy (n=5; 62.5%) (Forti-Buratti et
depression and intermittent depression. al., 2016; Klein et al., 2007; Méndez et al., 2021; Weisz et al., 2006;
Zhou et al., 2020), psychodynamic therapy (n=3; 37.5%) (Forti-Bu-
Characteristics of psychological interventions ratti et al., 2016; Méndez et al., 2021; Zhou et al., 2020), behaviour
therapy (n=3; 37.5%) (Cuijpers et al., 2021; Méndez et al., 2021; Zhou
The eight systematic reviews attempted to evaluate the effective- et al., 2020), computerised CBT (n=2; 25%) (Forti-Buratti et al., 2016;
ness of psychological interventions in the treatment of depressive dis- Zhou et al., 2020), problem-solving therapy (n=1; 12.5%) (Zhou et al.,
orders in the infant-juvenile population (see Table 1 for a summary of 2020) and supportive therapy (n=1; 12,5%) (Zhou et al., 2020).
the characteristics of psychological interventions). Similarly, several reviews evaluated the impact on depression in
Seven different psychotherapies were included: CBT was the most children and adolescents of other specific interventions such as biblio-
studied (n=7; 87.5%) (Cuijpers et al., 2020; Cuijpers et al., 2021; For- therapy-based CBT (n=2; 25%) (Méndez et al., 2021; Weisz et al., 2006)
ti-Buratti et al., 2016; Klein et al., 2007; Méndez et al., 2021; Weisz and family therapy based on emotional development (n=1; 12.5%)
et al., 2006; Zhou et al., 2020), as well as interpersonal therapy (IPT) (Forti-Buratti et al., 2016), as well as other treatments with psychologi-
(n=7; 87,5%) (Cuijpers et al., 2020; Cuijpers et al., 2021; Klein et al., cal components such as non-directive supportive therapy (n=3; 37.5%)
2007; Méndez et al., 2021; Pu et al., 2017; Weisz et al., 2006; Zhou et (Klein et al., 2007; Méndez et al., 2021; Weisz et al., 2006).
Table 1. Characteristics of included Systematic Reviews and Meta-analyses.
First author Aims Search strategy Type and number Participants’ Intervention’s Professionals Outcome Funding sources
(year of of studies characteristics characteristics providing the measures
publication) intervention
Cuijpers et a) Compare For the search for psychotherapy in N= 5 RCTs a) Children up to In the sample of Not reported. Priority was Not reported.
al. (2020)* the effects of children and adolescents: in children 13 years old with children: given to the
psychotherapy for Databases: PubMed y PsycINFO. (<13) and 15 in a mean of 10,6 Psychotherapies: information
depression between Search terms: (Psychotherapy adolescents (13 to (SD= NR), 50,2% Individual CBT reported
different age OR psychotherap* OR cbt OR 18 years old) of girls. Group CBT by the
groups. “behavior therap*” OR “behaviours 366 total RCTs. All of them had Others: parents and
b) Examine therapeutic” OR “behavioural a diagnosis of WL condition the results
whether the results therap*” OR “behavioural a depressive (from 9 to 15 provided by
reported differ by treatments” OR “cognition therap*” disorder and the sessions) the following
age group. OR “cognition treatment*” OR samples were In the sample measures:
psychodynamic OR psychoanalysis collected in the of adolescents: HAMD
OR counsel* OR “problem- US (80%) and Psychotherapies: BDI-I
solving” OR mindfulness OR in the United Group CBT BDI-II
(acceptance AND commitment) Kingdom (20%). Individual CBT PHQ-9
OR “assertiveness training” b) Adolescents in Individual IPT CES-D
OR “behavioral activation” OR the 13-18 range Others: HADS-D
“cognitive therap*” OR “cognitive (m= 15,45; SD= WL condition CDI
treatment*” OR “cognitive NR), 63,73% TAU RADS
restructuring” OR (“compassion- girls. (from 8 to 24
focused” OR “compassion The entire sessions)
focussed”)) AND (therapeutics sample presented
OR therapy OR therape OR a diagnosis
treatment) AND (constructivist* of depressive
OR “metacognitive therap*” OR disorder
“metacognitive treatment*” OR according to
“meta-cognitive therap*” OR a diagnostic
“meta-cognitive treatments*” interview and
OR “solution-focussed therap*” the origin of the
OR “solution focussed therap*” sample was US
OR “self-control therap*” OR (80%), Europe
“self-control training” OR “self (6,67%), Canada
control therap*” OR “self control (6,67%) and
training*”) AND (“Depressive Others (6,67%).
Disorder” OR dysthymi* OR
“affective disorder*” OR “mood
disorder*” OR depression OR
depress* OR “dysthymic disorder”)
AND ((“randomized controlled
trial” OR “controlled clinical trial”
OR randomized OR randomly
NOT animals NOT (animals AND
humans).
Cuijpers et a) Examine binary Databases: PubMed, PsycINFO, N= 17 RCTs of 40 a) Children and Psychotherapies: Not reported BDI This research did
al. (2021)* results using the Embase and Cochrane Library. total RCTs. adolescents up to Individual CBT BDI-II not receive external
validated method Trials were also identified by 18 years old (m= Group CBT CDI funding.
to estimate these analysing another recent meta- 14,31; SD= NR), Individual IPT CDI-II
results. analysis for recovery. 62,18% girls. Individual BT HAMD
b) Examine Search terms: (Psychotherapy b) The entire Others: MFQ-C
response, clinically OR psychotherap* OR cbt OR sample presented WL condition CDRS-C
significant “behavior therap*” OR “behaviours a diagnosis TAU
change, clinically therapeutic” OR “behavioural of depressive (from 8 to 41
significant therap*” OR “behavioural disorder sessions)
deterioration, treatments” OR “cognition therap*” according to
and recovery as OR “cognition treatment*” OR a diagnostic
outcomes. psychodynamic OR psychoanalysis interview.
OR counsel* OR “problem- c) The origin of
solving” OR mindfulness OR the sample was
(acceptance AND commitment) US (76,47%),
OR “assertiveness training” OR United Kingdom
“behavioral activation” OR “cognitive (11,76%), Europe
therap*” OR “cognitive treatment*” (5,88%) and
OR “cognitive restructuring” Others (5,88%).
OR (“compassion-focused” OR
“compassion focussed”)) AND
(therapeutics OR therapy OR
therape OR treatment) AND
(constructivist* OR “metacognitive
therap*” OR “metacognitive
treatment*” OR “meta-cognitive
therap*” OR “meta-cognitive
treatments*” OR “solution-focussed
therap*” OR “solution focussed
therap*” OR “self-control therap*”
OR “self-control training” OR “self
control therap*” OR “self control
training*”) AND (“Depressive
Disorder” OR dysthymi* OR
“affective disorder*” OR “mood
disorder*” OR depression OR
depress* OR “dysthymic disorder”)
AND ((“randomized controlled
trial” OR “controlled clinical trial”
OR randomized OR randomly
NOT animals NOT (animals AND
humans).
Forti- a) Evaluate Databases: Embase, Medline, N= 7 RCTs. a) n= 219 Psychotherapies: Not reported. PAPA For this study, the
Buratti et al. the efficacy of PsycINFO, Web of Knowledge participants. Individual CBT PFCS researchers received
(2016) psychological (including Web of Science, BIOSIS b) Age range 3-12. Group CBT CDI funding from the
treatments for Citation Index, Current Contents c) Participants CBTc BDI Alicia Koplowitz
depression in Connect, Derwent Innovations had MDD, PDNT CDRS Foundation (a
preteen children Index, CABI: CAB Abstracts, Chinese moderate MDD, FT AWBS fellowship to
(12 years and Science Citation Database, Data dysthymia and/ FT based on MFQ MAF) and were
younger). Citation Index, Journal Citation or resistant emotional RADS supported by the
Report). Published and unpublished depression. development NIHR Biomedical
studies (including dissertations) were d) The sample Others: Research Center
included and additional trials were was collected in TAU award to Imperial
also sought in systematic reviews and US (57,14%), WL condition College London.
published meta-analyses. United Kingdom No treatment
Search terms: (psychotherapy OR (14,28%), Psychological PL
“psychological treatment” OR Australia (from 6 to 30
“particular intervention”) AND (14,28%) and sessions - from 5
(depression OR “depressive disorder”) England, Greece to 12 weeks)
AND “child OR adolescent) AND and Finland
(random OR “clinical trial”). (14,28%).
Klein et al. a) Explain the Databases: PsycINFO and Medline. N= 11 RCTs. a) n= 809 Psychotherapies: It is reported Not The authors
(2007) differences between References from identified studies participants. Individual CBT that the reported. state that they
early and recent evaluating CBT results were also b) Age range 8-18 Group CBT treatment was have no financial
meta-analytical reviewed. (mean between Individual IPT performed in relationships to
estimates of the Search terms: “depression”, 12,7 and 16.2). Individual FT clinical settings disclose.
effects of cognitive “dysthymia” and “major c) Presented Individual NDST in 5 RCTs, so
behavioural therapy depression” with limited searches MDD and/ Others: the intervention
(CBT) on adolescent for populations of children and or dysthymia Relaxation was provided
depression. adolescents. according to Psychological PL by a health
b) Elucidate a diagnostic Pill PL professional.
the relationship interview or WL condition
between compliance with (from 5 to 16
methodology and the diagnostic sessions - 17,60
observed results. criteria of the hours of therapy
c) Quantify the DSM in any of its on average)
acute and follow-up versions or the
effectiveness of RDC.
CBT for young c) Populations
people with major included students,
depression. outpatients,
d) Systematically outpatient
assess the children and
methodological youth in the
rigour of CBT trials juvenile justice
for this population. system.
Méndez et a) Analyse, Databases: PsycINFO, PubMed, N= 22 RCTs of a) n= 2.295 Psychotherapies: Not reported. CES-D This research did
al. (2021)* from a historical ERIC, Web of Science and CSIC- psychotherapy of participants of Individual CBT BDI not receive external
3.501 included,
perspective, ISOC. Websites of institutions such 27 total RCTs. Group CBT BDI-II funding.
66,6% girls.
the state of as Division 53, Society of Clinical b) The samples Bibliotherapy- CBCL-D
psychological Child and Adolescent Psychology included an age based CBT SMFQ
treatments of the American Psychological range of 8-18 (m= Individual IPT MFQ
for adolescent Association (APA), National 15,0; SD = NR). Group IPT MFQ-C
c) Participants had
depression Institute for Health and Care FT K-SADS
MDD (87,4%),
according to the Excellence (NICE) and the Sistema dysthymia (10%), BT HRSD
criteria of evidence. Nacional de Salud (SNS) of Spain. DDNOS (0,9%) NDST CDRS-R
b) Provide Primary studies were also recovered and another PDNT QIDS
depressive disorder
healthcare from systematic reviews and meta- Others: CDI-2
(such as resistant
professionals analyses. depression) (5%). Relaxation
with guidelines Search terms: Not reported. d) Diversity in Social skills
for choosing the family structure, training
most appropriate socio-economic Reiki method
status and
treatment based on Psychological PL
ethnicity.
current evidence. e) 12 RCTs of Pill PL
psychotherapy WL condition
with 1.277 TAU
adolescents
(ftom 2 to 30
presented
comorbid weeks)
disorders: anxiety
disorders (43,1%),
disruptive and
behavioural
disorders (28,3%),
attention deficit
hyperactivity
disorder (17%)
and other
disorders (26,6%).
A RCT identified
comorbidity in its
participants with
inflammatory
bowel disease:
Crohn’s disease
(75%) or ulcerative
colitis (25%).
Pu et al. a) Evaluate the Databases: PubMed, Cochrane, N= 4 RCTs of 7 a) n= 231 Psychotherapies: Not reported. HAMD-24 This study was
(2017)* effectiveness and EMBASE, PsycINFO, Web of total RCTs. participants of Individual IPT CDI-27 supported by the
safety of IPT Science, and CINAHL. Additional 538 included. Others: BDI-21 National Basic
for adolescent eligible studies were also identified b) All studies WL condition Research Program
depression. by scanning the reference lists of recruited only Psychological PL of China (973
b) Evaluate the relevant studies. adolescents with TAU Program, Grant nº
effectiveness and Search terms: (depress* or dysthymi* an age range of (12 sessions - 2009CB918300);
acceptability of IPT OR “mood disorder*” OR “affective 12-18. from 6 to 16 Natural Science
for depression in disorder*” OR “adjustment c) All were weeks) Foundation of
adolescents. disorder*”) AND (adolesc* OR patients China (Grant nº
preadolesc* OR pre-adolesc* diagnosed with 31300881); and
OR child* OR boy* OR girl* OR a depressive Postdoctoral
infant* OR juvenil* OR minors disorder Scientific Research
OR paediatri* OR pediatri* OR according to Projects of
pubescen* OR puberty OR school* the diagnostic Chongqing (Grant
OR student* OR teen* OR young OR criteria of the nº Xm2015083).
youth* OR class* OR orphan* OR DSM in any of its
high-school OR “high school” OR versions.
preschool* OR pre-school*) AND
(psychotherap* OR psychological
OR interpersonal OR “interpersonal
therapy” OR “interpersonal
psychotherapy” OR IPT*).
Weisz et al. a) Evaluate the Databases: PsycINFO, Dissertation N= 16 RCTs of 35 a) n= 1.229 Psychotherapies Not reported. Not Not reported.
(2006)* effects of the most Abstracts International and total RCTs. participants of (group and reported.
widely proven
MEDLINE. 2.095 included, individual):
treatment gender of
juvenile depression: Reference lists of relevant review 62,5% girls. CBT
psychotherapy. articles and reference tracks b) The samples Bibliotherapy-
b) Determine the of outcome studies were also recruited based CBT
overall effect of examined. A manual search was participants with IPT
psychotherapy on
conducted in all issues from 1965 an age range of FT
juvenile depression.
c) Identify how to 2004 of those journals in which 8-18. NDST
long-lasting at least five psychotherapy studies c) They presented Others:
the effects of were identified through computer MDD, dysthymia, Relaxation
psychotherapy
searches and referrals; and personal MinDD, Social skills
are for juvenile
depression. communications were established DDNOS and/ training
d) Determine with relevant study authors to or intermittent WL condition
whether the effects identify any additional relevant depression Psychological PL
of psychotherapy studies. according to Pill PL
are specific to
Search terms: “depression”, a diagnostic TAU
depression or are
generalized to other “dysthymia” and “major interview or Symptom
conditions. depression” with limited searches compliance with monitoring
e) Comprobar si for populations of children and the diagnostic (mean= 13,3
la psicoterapia
adolescents. criteria of the hours; SD= 7,3)
juvenil supera las
condiciones de DSM in any of its
control activo. versions or the
f) Check DRC.
whether juvenile
psychotherapy
exceeds active
control conditions.
f) Assess whether
treatments that
emphasize cognitive
change are more
effective than
treatments that lack
cognitive emphasis.
g) Assess
whether juvenile
psychotherapy is
effective in clinically
representative
conditions.
Zhou et al. a) Synthesize all Databases: PubMed, Embase, N= 27 RCTs of a) n= 2.169 Psychotherapies Not reported. CDI This study was
(2020)* available evidence the Cochrane Central Register of psychotherapyof participants of (group and HAMD-14 financed by the
of antidepressants, Controlled Trials, Web of Science, 71 total RCTs. 9.510 included. individual): HAMD-17 National Key
psychotherapies PsycINFO, ProQuest, CINAHL and b) Age range 3-19 CBT HAMD-24 Research and
LiLACS.
and their (m= 14,17; SD= CBTc BDI-21 Development
In addition, manual searches
combinations NR). IPT MFQ Program of China
of published, unpublished and
commonly used c) Participants BT SMFQ (2017YFA0505700).
ongoing RCTs were conducted on
for the acute international trial registries, drug presented MDD, PDNT QIDS-A-Pat
treatment of approval agency websites, key dysthymia, FT CDRS-R
depressive disorder scientific journals, and summaries MinDD, PST
in children and of field conferences, and relevant DDNOS and/ SupT
adolescents. essay reference lists or review or intermittent Others:
b) Compare appendices. As well as contacting depression Psychological PL
and classify all the authors of the study to request according to TAU
complete reports of the original
available treatment the diagnostic WL condition
articles or data from unpublished
interventions for criteria of the (from 6 to 39
studies.
the acute treatment DSM in any weeks)
Search terms: (depress* or
of depressive dysthymi* OR “mood disorder*” version or based
disorders in OR “affective disorder*”) AND on a diagnostic
children and (adolesc* OR child* OR boy* interview.
adolescents. OR girl* OR juvenil* OR minors d) The sample
OR paediatri* OR pediatri* OR was collected
pubescen* OR school* OR student* in US (62,96%),
OR teen* OR young* OR youth OR United Kingdom
preschool OR “preschool*”) AND
(11,12%), Europe
(psychother* OR psychological* OR
(3,7%), Canada
cogniti* OR behavio* OR CBT OR
(3,7%), Australia
“family therap*” OR interpersonal
OR relaxation OR bibliotherap* (3,7%), Iran
OR “play therap*” OR “physical (3,7%), China
reinforcement” OR “reinforced (3,7%), Norway
practice” OR exposure* OR (3,7%) and
consultation* OR biofeedback* OR Turkey (3,7%).
“social skill*” OR “client centered*”
OR counsel* OR exercise* OR
psychoeducation* OR supportive*
OR “mental health*” OR “activity
scheduling”” OR art* OR dance*
OR dialectic* OR “emotion
focus*” OR “focus-oriented” OR
humanistic* OR integrative* OR
integrated* OR metacognitive* OR
meta cognitive* OR nondirective*
OR non-directive* OR “problem
solving*” OR psychodynamic*
OR “rational emotive*” OR “self
control*” OR “self talk*” or “self
help*” OR “stress management*”
OR “mind training*” OR
“functional analys*” OR
psychoanaly* OR psychodrama*
OR “role play*” OR mindfulness*).
Note: AWBS= Adolescent Well Being Scale; BDI= Beck Depression Inventory; BT= Behaviour Therapy; CBCL-D= Child Behavior Checklist-Depression;
CBT= Cognitive-Behavioural Therapy; CBTc= computerised Cognitive-Behavioural Therapy; CDI= Children’s Depression Inventory; CDRS-R= Chil-
dren’s Depression Rating Scale-Revised; CES-D= Center for Epidemiologic Study Depression Scale; DDNOS= Depressive Disorder Not Otherwise Specified;
DSM= Diagnostic and Statistical Manual of Mental Disorders; FT= Family Therapy; HADS-D= Hospital Anxiety and Depression Scale; HAMD= Ham-
ilton Rating Scale for Depression; HRSD= Hamilton Rating Scale for Depression; IPT= Interpersonal Therapy; K-SADS= Kiddie-Schedule for Affective Dis-
orders and Schizophrenia for School-Age Children; m= mean; MDD= Major Depressive Disorder; MFQ= Mood and Feelings Depression Questionnaire;
MFQ-C= Mood and Feelings Depression Questionnaire, Child version; MinDD= Minor Depressive Disorder; N= number of studies; n= number of partici-
pants; NDST= Non-Directive Supportive Therapy; NR= Not reported; PL= Placebo; PAPA= Preschool Age Psychiatric Assessment; PDNT= Psychodynamic
Therapy; PFCS= Preschool Feelings Checklist Scale; PHQ-9= The Depression Scale Of The Patient Health Questionnaire; PST= Problem-Solving Therapy;
QUIDS= Quick Inventory of depressive symptomatology; QUIDS-A-Pat= Quick Inventory of depressive symptomatology, adolescent version; RADS= Reyn-
olds Adolescent Depression Scale; RCT= Randomized Controlled Trials; RDC= Research Diagnostic Criteria; SD= Standard Deviation; SMFQ= The Short
Mood and Feelings Depression Questionnaire; SupT= Supportive Therapy; TAU= Treatment As Usual; US= United States; WL= Wait-list Condition.
*Information relevant to the present umbrella was extracted following the aim of this study, as these reviews and meta-analyses provided specific results on the
population of interest, which allowed for independent analysis.
The most used control condition was wait-list (n=8; 100%) and than noncognitive approaches (such as IPT), subsequent reviews and
treatment as usual (n=7; 87.5%) (Cuijpers et al., 2020; Cuijpers et al., meta-analyses identified significant differences in favour of CBT as a
2021; Forti-Buratti et al., 2016; Méndez et al., 2021; Pu et al., 2017; treatment for infantile-juvenile depression, demonstrating the efficacy
Weisz et al. 2006; Zhou et al., 2020). of this specific psychotherapy against the control group in samples of
Regarding the format of psychotherapy, 5 reviews (62.5%) included adolescents (Klein et al., 2007) and facing the waiting list in mixed
studies applying interventions in both group and individual modality samples (Zhou et al., 2020); therefore, following the results found by
(Cuijpers et al., 2020; Cuijpers et al., 2021; Forti-Buratti et al., 2016; Méndez et al. (2021) in their systematic review, CBT in individual
Klein et al., 2007; Méndez et al., 2021), 2 (25%) reported to include modality can be considered a well-established treatment for adolescent
interventions in both modalities (group and individual) but did not depression according to the criteria of the Journal of Clinical Child
explain what format each type of psychotherapy had adopted (Weisz et and Adolescent Psychology and possibly efficacious when applied in
al., 2006; Zhou et al., 2020), 1 review (12.5%) included exclusively stud- group. The review also concluded that both computerized CBT and
ies with an individual format (Pu et al., 2017). In addition, no studies bibliotherapy-based CBT are in the experimental phase, as they did
reported information about the professionals providing the interven- not show significant symptom reduction.
tions, but one review (Klein et al., 2007) indicated that the treatment However, it should be noted the difficulties encountered in the
was performed in clinical settings in 5 RCTs, so it can be understood meta-analyses that evaluated the effects of treatments for depression
that the intervention was provided by a health professional. in children, since, after the study of this population, Forti-Buratti et
With regard to the duration of treatment, there were differences al. (2016) concluded that there is not enough evidence to allow us to
in the way data were provided, since reviews used weekly measures confidently evaluate the effectiveness of psychological interventions,
(n=2; 25%) (Méndez et al. 2021; Zhou et al., 2020), others evaluated so, although CBT is the most studied therapy for this age range, even
the sessions of the interventions (n=3; 37.5%) (Cuijpers et al., 2020; for this therapy the number of participants included in the trials is
Cuijpers et al., 2021; Klein et al., 2007) and others used both methods relatively small and therefore there is no clear evidence that the treat-
(n=2; 25%) (Forti-Buratti et al., 2016; Pu et al., 2017), except Weisz et ment is effective.
al. (2006) which reported an average duration of 13.3 hours (SD=7.3). On the other hand, it was found that individual IPT is an effective
Therefore, the interventions were developed in a range of 2 to 30 and acceptable intervention for juvenile depression, showing a much
weeks and from 5 to 41 sessions. higher efficacy than all psychological controls (Pu et al., 2017; Zhou
Finally, the main evaluation tools used to evaluate children and et al., 2020) and improvements in the quality of life and functioning
adolescents depression were: the Beck Depression Inventory (BDI; of adolescents were identified (Pu et al., 2017). This type of therapy
Beck et al., 1996) and the Children’s Depression Inventory (CDI; can be considered a well-established individual treatment for adoles-
Kovacs, 1992), present at all reviews, except those of Klein et al. (2007) cent depression and an experimental treatment in group format, not
and Weisz et al. (2006), which did not provide information on the working with representative samples (Méndez et al., 2021).
outcome measures, followed by Hamilton Depression Rating Scale With respect to family therapy, there were mixed results between
(HAMD and HRSD; Cusin et al., 2009), by the Children’s Depression the reviews and meta-analyses analysed, so it could be considered
Rating Scale (CDRS-R) (Poznanski & Mokros, 1996) and by the Mood a possible efficacious treatment in adolescents (Méndez et al., 2021),
and Feelings Questionnaire (MFQ; Wood et al., 1995). while the evidence found on the efficacy of family therapy aimed at
treating depression in samples of children is very weak, so no firm
Effectiveness of psychological interventions conclusions can be drawn (Forti-Buratti et al., 2016). Similarly, it hap-
pens with psychodynamic therapy, for which no evidence was found
The summary of the main results found in the systematic reviews either in favour of children (Forti-Buratti et al., 2016) or adolescents
and meta-analyses included is presented in Table 2. (Méndez et al., 2021), or in mixed samples (Zhou et al., 2020), so the
Of the 8 reviews, all provided a qualitative and quantitative absence of significant differences suggests that psychodynamic ther-
synthesis of the results of the individual studies, so all conducted apy is an experimental treatment at this time (Méndez et al., 2021).
a meta-analysis, with the exception of Méndez et al. (2021), which Finally, the meta-analyses analysed demonstrated the superiority
performed a narrative analysis. Overall, reviews reported on the of supportive therapy and problem-solving therapy to the wait-list
effectiveness of psychological interventions in decreasing depressive condition (Zhou et al., 2020), and identified inconsistent outcomes
symptoms in post-treatment. in relation to behavioural therapy with respect to the control group
The reviews analysed confirmed the efficacy of psychotherapy in (Zhou et al., 2020).
the treatment of child and young people depression, since a reduction
of depressive symptoms was found clinically significant in young peo- Methodological quality and risk of bias
ple who had received a psychological intervention in front of the con-
trol group, both active and passive (Cuijpers et al., 2020; Cuijpers et The results of the evaluation of the methodological quality and risk of
al., 2021; Weisz et al., 2006). In addition, psychological interventions bias of the systematic reviews and meta-analyses included are summarized
for depression in children and adolescents also showed generality and in Table 3. Following the quality rating provided by the AMSTAR-2 tool
specificity, as anxiety symptoms among participants were reduced (Shea et al., 2017), half of the studies (n=4) presented a low quality, as they
but externalizing problems such as behavioural problems were not had a critical weakness with or without weak points, while the other half
reduced, as reflected in the meta-analysis by Weisz et al. (2006). It was (n=4) were rated as critically low because they had more than one critical
also confirmed that the positive effects of psychotherapy remain for weakness. This is mainly because most reviews do not report on the crea-
months after treatment, but that more evidence is needed with respect tion of a protocol prior to conducting the meta-analysis, as required in Item
to long-term effects (Weisz et al., 2006). 2, does not provide a list of excluded studies and justification for exclusions
Concretely, although Weisz et al. (2006) concluded that treat- (Item 7) or does not report on funding sources for RCTs (Item 10).
ments that include cognitive components do not present better results
Table 2. Summary of Results
First author Risk of bias Main findings Effect estimates (if meta-
(year of analysis
publication) was performed)
Cuijpers et al. The risk of bias was measured by a) Statistically significant improvement was identified between Efficacy:
(2020) the analysis of 4 criteria: adequate the experimental group and the control group of children and Interventions focused on
generation of the allocation sequence, adolescents with a diagnosis of a depressive disorder, which children with a depressive
concealment of the assignment to the demonstrated the efficacy of psychotherapy in the treatment of disorder:
conditions, masking of the evaluators infant-juvenile depression. N= 5; g of Hedge’s = 0.58;
and dealing with incomplete result data. b) Although psychotherapies for children and adolescents 95% CI: -0.10 to 1.25; (p
Of the RCTs composed of a sample of diagnosed with depression showed medium sizes of effect, < .001).
children, 3 presented a high risk of bias these were significantly smaller than those found in adults so Interventions focused
and 2 a risk of unclear bias. Of the RCTs treatments might not be as effective for this population as for on adolescents with a
that evaluated the efficacy of treatments other age cohorts. depressive disorder:
in a sample of adolescents, 5 presented c) For the interpretation of the results should be taken into N= 15; g of Hesge’s = 0.56;
a high risk of bias, 8 presented an account the low quality of the studies, especially those that 95% CI: 0.24 to 0.88; (p
unclear risk of bias and the remaining 2 include samples <13 years, since this condition can hinder < .001).
presented a low risk of bias, since they the establishment of firm conclusions, reason why further
met all the quality criteria. study of psychotherapy for depression in children would be
recommended.
Cuijpers et al. The risk of bias was measured by a) A clinically significant improvement was found in young Response rate of
(2021) the analysis of 4 criteria: adequate people in therapy compared to control groups. interventions focused on
generation of the allocation sequence, b) When subgroup analysis was performed, significant children and adolescents
concealment of the assignment to the differences were identified in participants with a diagnosis of with a depressive
conditions, masking of the evaluators a depressive disorder, since the response rate was considerably disorder:
and dealing with incomplete result higher in RCTs targeting this population compared to studies N= 17; ES = 0.43; 95% CI:
data. Of the RCTs analysed, 5 presented in which participants had to score above a limit. 0.33 to 0.54; (p = 0.04).
a high risk of bias, 9 a risk of unclear c) Psychotherapies for depression in young people are effective
bias and the remaining 3 presented a compared to control conditions, but more effective treatments
low risk of bias, since they met all the and treatment strategies are needed.
quality criteria.
Forti-Buratti et The risk of bias was assessed using an a) Not enough evidence to allow to confidently evaluate the Efficacy:
al. (2016) adapted version of the Jadad score. 4 effectiveness of psychological interventions for children 12 - CBT vs. control (both
of the RCTs analysed had the highest years of age or younger with depression, so, from these data, it active and passive). (SMD
adapted Jadad score (5/5) and otor is not possible to draw firm conclusions about the efficacy of = -0.342; 95% CI: -0.961
trial achieved a score of 4/5, so they specific psychotherapies aimed at this population. This is due to 0.278; p = 0.280).
presented a low risk of bias. A RCT to the lack of studies investigating depression in this age group
obtained a score of 3/5, evidencing an and the small size of the samples used.
unclear risk of bias, since the blinding b) CBT is the therapy most studied for this age range, but even
of the evaluator was not reported. While for this therapy, the number of trial participants is relatively
the remaining RCT obtained a score of small and therefore there is no clear evidence that treatment is
1/5, indicating a high risk of bias, it did effective. Similarly, for other psychological treatments, such as
not report any description of blinding FT and PDNT the evidence base is even weaker.
or random allocation method. c) Given the prevalence and significant impact of this disorder,
further research is absolutely necessary, with a larger number
of participants since there is an urgent need to establish the
effectiveness or not of the psychological intervention.
Klein et al. The number of CONSORT criteria a) Significant differences were identified in favor of CBT as a Efficacy:
(2007) met in each study ranged from 14 to treatment for adolescent depression, so the results of the meta- - CBT vs. control (both
21 (mean 17.4). The unfulfilled criteria analysis support the efficacy of this specific psychotherapy. active and passive). (SMD
reflected a lack of attention to the way b) With regard to previous meta-analyses, it was found that = 0.53; 95% CI: 0.24 to
in which sample sizes were determined, the effects of CBT have decreased since the CBT study was 0.82).
the methods used to generate and initiated as a treatment for juvenile depression and that
implement random group assignment, confidence intervals have become narrower. This can be
the blinding of researchers to the explained by the methodological differences seen in recent
allocation of groups and the incidence RCTs compared to early research, as the smaller treatment
of adverse effects. effects were associated with the comparison of the effects
of CBT with the control conditions of active treatment,
the administration of treatment in clinical settings and the
application of greater methodological rigour.
c) In order to promote greater methodological rigour in future
trials, it will be important for researchers to conduct future
studies based on the CONSORT (Consolidated Standards of
Test Reports).
Méndez et al. Not reported. Following the criteria of the Journal of Clinical Child and Not reported.
(2021) Adolescent Psychology:
a) CBT is the most studied psychotherapy and it has been
shown that, applied individually, it is superior to FT, NDST,
relaxation training, Reiki method, treatment as usual,
psychological placebo and wait-list condition. Therefore, CBT
in individual mode is a well-established treatment.
b) CBT has shown positive evidence when applied in a group,
being superior to social skills training and wait-list condition,
so it could be considered a probably effective treatment.
c) Both CBTc and bibliotherapy-based CBT showed no
significant symptom reduction and are therefore in the
experimental phase.
d) Individual IPT is presented as a well-established treatment
for adolescent depression because there are at least two RCTs
in which it has been as effective as CBT (a proven treatment)
and superior to the treatment as usual.
e) The group IPT would be in an experimental phase because
the samples used by the RCTs analysed are not representative.
f) Mixed results were obtained in RCTs that analysed the
efficacy of FT, since in two trials the FT was superior to the
treatment as usual and the wait-list condition, while in the
other two trials no differences were found with respect to
the usual treatment and SupT and it was found to be lower
than CBT. Therefore, the status of the FT would possibly be
effective.
g) Short-term PDNT was not more effective than CBT or
a short-term psychosocial intervention, so the absence of
significant differences in outcome suggests that PDNT is an
experimental treatment at this time.
Pu et al. The 4 RCTs had a low risk of bias. a) IPT is an effective and acceptable intervention for Efficacy of interventions
(2017) adolescents with depression. targeting adolescents
b) Compared to control conditions, IPT is an effective with depressive disorders
treatment to reduce symptoms of depression and increase defined by DSM:
response/remission rates after treatment in adolescents with - IPT vs. control (both
depression. active and passive). (SMD
c) IPT can significantly improve quality of life and functioning = -0.81; 95% CI: -1.09 to
in adolescents and reduce dropout or interruption rates (for -0.54; p < .001).
any reason) of treatment.
Weisz et al. Not reported. a) Treatments for juvenile depression appear to produce effects Efficacy of interventions
(2006) that are significant but modest in their strength, breadth and aimed at diagnosed
durability. samples:
b) The authors applied rigorous analytical methods and - Psychotherapy vs.
identified significant effects of psychotherapy for children control (both active and
and adolescents depression, although markedly more modest passive). (N= 16; WLS =
than those reported in previous meta-analyses and for other 0.35; z = 3,39; p < .01).
conditions.
c) The mean ESs of the studies with diagnosed samples and the
RCTs that recruited participants with high symptomatology
did not differ significantly. In addition, studies using a
diagnosis included older participants.
d) Treatments that include cognitive components did not
perform better than non-cognitive approaches (such as IPT).
e) The effects of psychotherapy for depression in children
and adolescents showed generality (anxiety was reduced) and
specificity (externalization problems were not reduced).
f) The effects appear to be lasting for the first few months after
treatment; however, more evidence is needed regarding long-
term effects.
g) Much has been achieved in 25 years of research on the
treatment of juvenile depression, but important work remains.
Critical examination of evidence suggests the need for greater
use of active control conditions, a meaningful monitoring
evaluation and an evaluation of moderators.
Zhou et al. 21 RCTs were classified as high risk of a) IPT was shown to be superior to all psychological controls Efficacy:
(2020) bias, while the remaining 6 presented an (psychological placebo, treatment as usual and wait-list - IPT vs. psychological PL
unclear risk of bias. condition) in the treatment of infantile-juvenile depression (SMD = -0.70; 95% CI:
when post-treatment outcomes were analysed. -1.29 to -0.12).
b) Statistically significant decrease in depressive symptoms was - IPT vs. TAU (SMD =
identified in children and adolescents who had been treated -0.66; 95% CI: -1.22 to
with CBT, FT, PST and SupT compared to the group who in -0.09).
wait-list condition during post-treatment. - IPT vs. WL condition
c) No evidence was found in favour of BT and NT when (SMD = -1.37; 95% CI:
compared with any control group. -2.04 to -0.70).
- CBT vs. WL condition
(SMD = -0.94; 95% CI:
-1.40 to -0.48).
- FT vs. WL condition
(SMD = -1.03; 95% CI:
-1.66 to -0.40).
- PST vs. WL condition
(SMD = -1.26; 95% CI:
-2.48 to -0.03).
- SupT vs. WL condition
(SMD = -0.89; 95% CI:
-1.78 to -0.01).
- BT vs. control. (SMD
= 0.16; 95% CI: -1.87 to
2.08).
- PDNT vs. control (SMD
= 0.01; 95% CI: -1.42 to
0.94).
Note: BT= Behaviour Therapy; CI= Confidence Interval; CBT= Cognitive-Behavioural Therapy; CBTc= computerised Cognitive-Behavioural Therapy; DSM=
Diagnostic and Statistical Manual of Mental Disorders; ES= Effect Size; FT= Family Therapy; IPT= Interpersonal Therapy; m= mean; N= number of studies;
NDST= Non-Directive Supportive Therapy; PDNT= Psychodynamic Therapy; PST= Problem-Solving Therapy; TPL= Placebo; RCT= Randomized Controlled
Trials; SD= Standard Deviation; SMD= Standardized Mean Difference, SupT= Supportive Therapy; TAU= Treatment As Usual; WL= Wait-list Condition; WLS=
Weighted Least Squares.
Table 3. Methodological Quality and Risk of Bias of the Studies Included in this Umbrella Review.
AMSTAR-2 Items
Study Item Item Item Item Item Item Item Item Item Item Item Item Item Item Item Item Quality
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 rating
Cuijpers et Critically
+ - + +/- + + - +/- + - + + + + + +
al. (2020) Low
Cuijpers et Low
+ + + +/- + + - +/- + - + + + + + +
al. (2021)
Forti- Low
Buratti et + - - + + + + + + - + - + + + +
al. (2016)
Klein et al. Critically
+ - + +/- + + - + + - + + + - - +
(2007) Low
Méndez et Critically
+ - + + + + + + - - NM NM - - NM +
al. (2021) Low
Pu et al. Low
+ - - +/- + + + + + - + + + - + +
-2017
Weisz et al. Critically
+ - + + - + - + - - + - + + - -
-2006 Low
Zhou et al. Low
+ + - + + + - + + + + + + + + +
(2020)
Note: Yes: +; Partial yes: +/-; No: -. NM: Not meta-analysis.
Discussion questions posed by the research.

Systematic reviews of published studies have shown that psycho-
This systematic review has synthesized the results of the system- therapy has generally been proved to be superior to the control group
atic reviews and meta-analysis published in the last two decades about in post-treatment and follow-up evaluations, and showing a generali-
the effectiveness of psychological interventions for the treatment of sation of the results, having a positive impact on other disorders such
depression in childhood and adolescence in order to answer some as anxiety (Weisz et al., 2006). This is consistent with the position taken
by different governmental entities, such as NICE (2019), which rec- pendently in order to draw firm conclusions regarding the ideal treat-
ommends psychotherapy as the first-line treatment for children and ment for the clinical population.
adolescents with depression, due to its safety and high acceptability. All this indicates that, although much has been achieved in the
Regarding specific interventions, there is consensus in the last 20 years of research on the treatment of depression during the
meta-analyses included in the present review of reviews about the childhood and adolescence, there is a need for a greater proliferation
efficacy of IPT in reducing levels of depression in adolescents, having of research in this field, ensuring the quality of studies, using repre-
positive effects on the quality of life and functioning of young peo- sentative samples.
ple (Pu et al., 2017; Zhou et al., 2020), so it can be considered one
of the main psychotherapies for the treatment of depression in this Limitations and future directions
population. More specifically, it can be considered a well-established
treatment for adolescent depression in an individual format and an Despite the findings of this work, it is important to emphasize the
experimental treatment in group format according to the criteria of limitations of the present systematic review of systematic reviews in
the Journal of Clinical Child and Adolescent Psychology (Méndez et order to guide future research. First, although this umbrella review
al., 2021). This coincides with the umbrella proposed by Correll et al. also synthesized relevant aspects of the characteristics of the interven-
(2021), which recommends IPT as the main psychosocial interventions, such as the duration of treatment, the analyses were carried out
tion in juvenile depression. without considering these variables and moderators since insufficient
Regarding CBT, despite the discrepancies found in the meta-anal- information was available due to the heterogeneity of the studies;
ysis of Zhou et al. (2020), it can be said that the empirical evidence therefore, it is advisable that future reviews examine how the different
found in the meta-analysis analysed in this review is sufficient to ver- characteristics of the therapy may influence its effectiveness.
ify and confirm the efficacy of CBT in the treatment of young people With regard to the inclusion criteria, it is important to note that
with depression (Klein et al., 2007), being a well-established treatment restrictions were placed on the English and Spanish languages for
for adolescent depression in individual modality and possibly effica- practical reasons, so it is possible that some revisions about the subject
cious when applied in group (Méndez et al., 2021), as demonstrated by have been omitted. Another limitation is the possible overlap of stud-
the review of reviews of Crowe and McKay (2017). However, no evi- ies, since the selected meta-analyses, in some cases, included the same
dence was found in favour of computerised CBT, which differs from trials, so those studies were considered more than once in the analysis,
the results found in the umbrella of Domhardt et al. (2018), who found which could have biased some results, being an issue to consider in
significant effects in favor of computerised CBT in the treatment of future umbrella. Similarly, another important limitation of this work
depression in children and adolescents. This difference may be due to is the low methodological quality of the included reviews, according
the fact that Domhardt et al. (2018) included in their review samples to the ratings of AMSTAR-2 (Shea et al., 2017), which weakens the
with depressive symptoms mainly, so a diagnosis was not required. evidence reported in this systematic review of reviews.
In relation to the effectiveness of other types of psychotherapy, Finally, it should be noted that, although most of the reviews
family therapy could be considered a possibly efficacious treatment in included mixed samples (n=6; 75%), in the meta-analysis carried
adolescents (Méndez et al., 2021), while the reviews analysed suggest out by Forti-Buratti et al. (2016), where the efficacy of treatments for
that psychodynamic therapy, supportive therapy, behavioural therapy, childhood depression was evaluated (children up to 12 years old), no
problem-solving therapy, and bibliotherapy-based CBT are in the solid conclusions could be drawn due to the lack of studies investi-
experimental phase at this time (Forti-Buratti et al., 2016; Méndez et gating depression in this age group and the small size of the samples
al., 2021; Zhou et al., 2020). used, so it cannot be confirmed that the findings found in the present
An analysis of the progress made in the last two decades in the review of reviews can be generalized to the child population, due to
investigation of psychological treatments for depression in children the influence that the presence of a greater number of adolescents in
and adolescents reveals an increase in publications, especially in the the analysed samples may have.
last 5 years, which are characterized by following a more rigorous It is, therefore, advisable to carry out new systematic reviews and
methodology, with special emphasis on published RCTs, which have higher quality meta-analyses to improve the level of evidence of psy-
allowed to address depression in children and adolescents from dif- chological interventions for the treatment of children and adolescents
ferent perspectives and obtain more accurate data on the effectiveness with a diagnosis of a depressive disorder, as well as increased research
of psychotherapy. in this field leading to the development of RCTs in children. In addi-
However, critical analysis of the existing evidence allows to iden- tion, new studies that contrast evidence of other types of psychother-
tify a significant difference with respect to effect sizes, since, while it is apy, such as family therapy or problem-solving therapy, would also be
true that psychotherapies intended for children and adolescents with desirable due to conflicting and inconsistent results.
a diagnosis of depression have shown medium effect sizes, confidence
intervals have become narrower (Klein et al., 2007) and effect sizes are Conclusion
noticeably more modest than those reported in previous meta-anal-
yses and for other conditions (Weisz et al., 2006) and significantly From the present systematic review of systematic reviews and
smaller than those found in adults, which indicates that treatments meta-analyses, it can be concluded that, in general, psychological
may not be as effective for this population as for other age cohorts interventions for infant-juvenile depression appear to produce effects
(Cuijpers et al., 2020). that are significant but modest in their strength, breadth and durabil-
It should also be noted that the research has focused on the study ity. More specifically, the umbrella highlights the effectiveness of inter-
of the efficacy of treatments aimed at samples that included both clini- personal therapy in the treatment of adolescent depression, followed
cal population with a diagnosis of a depressive disorder, and non-clin- by CBT, showing very positive results in reducing levels of depression,
ical population, where participants presented symptomatology with so they can be considered the main treatment alternatives. Despite
varying degrees of severity, making it difficult to analyse data inde- the efficacy of these psychotherapies, these data cannot be generalized
to the infant population (children <12 years old) due to the lack of Domhardt, M., Steubl, L., & Baumeister, H. (2018). Internet- and Mobile-Based
representative samples and studies of depression in this age group. Interventions for Mental and Somatic Conditions in Children and Ado-
Although there are many studies that analyses the efficacy of treat- lescents. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie,
ments for depressive disorders, it is identified a clear lack of research 48(1), 33–46. https://doi.org/10.1024/1422-4917/a000625
of this population that makes it difficult to establish firm conclusions. Erskine, H., Baxter, A., Patton, G., Moffitt, T., Patel, V., Whiteford, H., & Scott,
Additional studies are suggested in an attempt to address this problem J. (2017). The global coverage of prevalence data for mental disorders in
and evaluate new forms of treatment. children and adolescents. Epidemiology and Psychiatric Sciences, 26(4),
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Declaration of conflict of interest Flament, M. F., Cohen, D., Choquet, M., Jeammet, P., & Ledoux, S. (2011).
Phenomenology, psychosocial correlates and treatment seeking in major
The authors declare no conflicts of interest. depression and dysthymia in adolescence. Journal of the American
Academy of Child & Adolescent Psychiatry, 40(9), 1070-1078. https://doi.
org/10.1097/00004583-200109000-00016
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