Room for improvement: New study suggests that the majority of kids don’t respond to depression treatment

Cuijpers, et al. (2023) The effects of psychological treatments of depression in children and adolescents on response, reliable change, and deterioration: a systematic review and meta-analysis. Child & Adolescent Psychiatry (2023) 32:177–192

The Study

Researchers conducted such  meta-analysis to examine children and adolescents’ response to of psychological treatments of depression , including clinically significant change. They combed four bibliographic databases and included 40 randomized trials comparing psychotherapy for youth depression against control conditions.

The findings

Overall, less than half of youth (39%) of those receiving therapy respond within 2 months. In the control conditions, this rate is lower 24%, but the additional benefit of therapies above the control condition was pretty modest.

As the authors note, “This means that the majority of children and adolescents do not respond to the therapies tested in these studies to date, and a considerable number would also have responded without therapy. These findings make clear that new, more effective treatments are needed to further reduce the burden of depression in these age groups.

Future research should also examine potential reasons why children and adolescents do not respond and whether for example enhancing treatment fidelity, optimizing delivery methods, combination treatments, personalized approaches or sequential treatments may increase response rates. It should be noted that it is also important that future studies not only report continuous outcomes, but also binary outcomes such as response and remission, because of the clinical relevance of such outcomes…

[Overall] this study showed that psychotherapies for depression in children and adolescents are effective compared to control conditions, but that still more than half of patients receiving therapy do not respond. Furthermore, a considerable number of those in control groups also respond. More effective treatments and treatments for those not responding to a first treatment are clearly needed.

Implications for mentoring

There was a lot of variability in the quality of the treatments (as there is with mentoring). Overall, these findings are a reminder that mentoring programs (which are typically not as goal focused) may not be having the effects we’re hoping for, and that many of the youth on the waitlist may get better on their own. Where possible, programs should include a binary outcome since that’s what many parents want to know. We should be continuously looking for ways to improve our practice.