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Meta-Analysis
. 2020 Jul 1;77(7):694-702.
doi: 10.1001/jamapsychiatry.2020.0164.

Psychotherapy for Depression Across Different Age Groups: A Systematic Review and Meta-analysis

Pim Cuijpers  1 , Eirini Karyotaki  1 , Dikla Eckshtain  2 , Mei Yi Ng  3 , Katherine A Corteselli  4 , Hisashi Noma  5 , Soledad Quero  6 , John R Weisz  4
Affiliations
Meta-Analysis

Psychotherapy for Depression Across Different Age Groups: A Systematic Review and Meta-analysis

Pim Cuijpers et al. JAMA Psychiatry. .

Abstract

Importance: It is not clear whether psychotherapies for depression have comparable effects across the life span. Finding out is important from a clinical and scientific perspective.

Objective: To compare the effects of psychotherapies for depression between different age groups.

Data sources: Four major bibliographic databases (PubMed, PsychINFO, Embase, and Cochrane) were searched for trials comparing psychotherapy with control conditions up to January 2019.

Study selection: Randomized trials comparing psychotherapies for depression with control conditions in all age groups were included.

Data extraction and synthesis: Effect sizes (Hedges g) were calculated for all comparisons and pooled with random-effects models. Differences in effects between age groups were examined with mixed-effects subgroup analyses and in meta-regression analyses.

Main outcomes and measures: Depressive symptoms were the primary outcome.

Results: After removing duplicates, 16 756 records were screened and 2608 full-text articles were screened. Of these, 366 trials (36 702 patients) with 453 comparisons between a therapy and a control condition were included in the qualitative analysis, including 13 (3.6%) in children (13 years and younger), 24 (6.6%) in adolescents (≥13 to 18 years), 19 (5.2%) in young adults (≥18 to 24 years), 242 (66.1%) in middle-aged adults (≥24 to 55 years), 58 (15.8%) in older adults (≥55 to 75 years), and 10 (2.7%) in older old adults (75 years and older). The overall effect size of all comparisons across all age groups was g = 0.75 (95% CI, 0.67-0.82), with very high heterogeneity (I2 = 80%; 95% CI: 78-82). Mean effect sizes for depressive symptoms in children (g = 0.35; 95% CI, 0.15-0.55) and adolescents (g = 0.55; 95% CI, 0.34-0.75) were significantly lower than those in middle-aged adults (g = 0.77; 95% CI, 0.67-0.87). The effect sizes in young adults (g = 0.98; 95% CI, 0.79-1.16) were significantly larger than those in middle-aged adults. No significant difference was found between older adults (g = 0.66; 95% CI, 0.51-0.82) and those in older old adults (g = 0.97; 95% CI, 0.42-1.52). The outcomes should be considered with caution because of the suboptimal quality of most of the studies and the high levels of heterogeneity. However, most primary findings proved robust across sensitivity analyses, addressing risk of bias, target populations included, type of therapy, diagnosis of mood disorder, and method of data analysis.

Conclusions and relevance: Trials included in this meta-analysis reported effect sizes of psychotherapies that were smaller in children than in adults, probably also smaller in adolescents, that the effects may be somewhat larger in young adults, and without meaningful differences between middle-aged adults, older adults, and older old adults.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Noma reported personal fees from Boehringer Ingelheim, Kyowa Hakko Kirin, and ASKA Pharmaceutical outside of the submitted work. Dr Cuijpers received expense allowances for his membership of the Board of Directions of “Mind.nl,” for being Chair of the Research committee of the Dutch Council for military care and research, and for being Chair of the Mental Health Priority Area of the Wellcome Trust in London, England, in 2018. In addition, he received royalties for books he has authored or coauthored and for occasional workshops and invited addresses. Dr Weisz received payments for consulting with the Child Health and Development Institute and the National Institute of Mental Health, royalties for books he has authored and coauthored, and honoraria for workshops and invited presentations at professional meetings and conferences. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Effect Sizes of Psychotherapies in Different Age Groups
Figure 2.
Figure 2.. Bubble Plot of the Effect Size as Dependent Variable and Mean Age of the Population as Predictor
The size of the dots reflect the study sample size.
See this image and copyright information in PMC

Comment in

References

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