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Systematic review of efficacy of cognitive behaviour therapies in childhood and adolescent depressive disorder

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7144.1559 (Published 23 May 1998) Cite this as: BMJ 1998;316:1559
  1. Richard Harrington, professora (R.C.Harrington{at}man.ac.uk),
  2. Jane Whittaker, tutora,
  3. Philip Shoebridge, research workera,
  4. Fiona Campbell, medical statisticianb
  1. a Department of Child and Adolescent Psychiatry, Royal Manchester Children's Hospital, Manchester M27 1HA
  2. b Research and Development Support Unit, Hope Hospital, Salford, Manchester M6 8HD
  1. Correspondence to: Professor Harrington
  • Accepted 13 April 1998

Abstract

Objective: To determine whether cognitive behaviour therapy is an effective treatment for childhood and adolescent depressive disorder.

Design: Systematic review of six randomised trials comparing the efficacy of cognitive behaviour therapy with inactive interventions in subjects aged 8 to 19 years with depressive disorder.

Main outcome measure: Remission from depressive disorder.

Results: The rate of remission from depressive disorder was higher in the therapy group (129/208; 62%) than in the comparison group (61/168; 36%). The pooled odds ratio was 3.2 (95% confidence interval 1.9 to 5.2), suggesting a significant benefit of active treatment. Most studies, however, were based on relatively mild cases of depression and were of only moderate quality.

Conclusions: Cognitive behaviour therapy may be of benefit for depressive disorder of moderate severity in children and adolescents. It cannot, however, yet be recommended for severe depression. Definitive large trials will be required to determine whether the results of this systematic review are reliable.

Key messages

  • Depressive disorders are a common problem in child psychiatric clinics, but a recent systematic review found that tricyclic medication was of unproved benefit

  • This systematic review identified six randomised trials of a psychological treatment—cognitive behaviour therapy—in subjects aged 8 to 19 years with depressive disorder

  • The results seemed to show that cognitive behaviour therapy is an effective treatment for depressive disorder of moderate severity

  • Because of the small number of trials available for this quantitative analysis definitive large trials will be required to determine whether the present results are reliable

Footnotes

    • Accepted 13 April 1998
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