Effectiveness of Psychotherapy for Internalising Symptoms in Children and Adolescents When Delivered in Routine Settings: A Systematic Review and Meta-analysis

Abstract

This systematic review and meta-analysis aimed to examine the effectiveness of psychological interventions for internalising disorders in youth when delivered in routine settings. Secondary aims were to examine the effectiveness of cognitive behavioural therapy and determine moderators of treatment response. The study was pre-registered (PROSPERO 2020 CRD42020202776). Databases were systematically searched (PsycINFO, Medline, Embase, PubMed, ERIC) in December 2022 and screened according to the PRISMA 2020 statement. Inclusion: School aged participants (4-18 years) with a primary internalising disorder; psychotherapy delivered in a routine setting (e.g. outpatient clinic, school) by setting staff; compared psychotherapy to any control in a randomised controlled trial; reported pre-to-post or pre-to-follow-up comparisons on the primary disorder according to child, parent or independent evaluator report; and was published in English. Risk of bias was assessed using the ROB 2.0 Cochrane tool. Results were synthesised using random effects to pool estimates. Risk ratios were used to analyse dichotomous data and standardised mean differences (SMD) for continuous data. Forty-five studies were included (N = 4901 participants; M = 13 years; range 8-16; SD = 2.5). Nine used waitlist control, 17 treatment as usual, 4 placebo; 15 compared psychotherapy to active control. Psychotherapy was associated with small significant effects pre- to post-treatment compared to non-active controls for anxiety (SMD = - 0.24 to 0.50) and depression (SMD = - 0.19 to 0.34) with effects differing by informant. Psychotherapy led to small significant pre-to-post-benefits in youth internalising disorders in routine settings. Results are limited by reporter type and follow-up.

Keywords: Anxiety; Depression; Effectiveness; Meta-analysis; Systematic review; Youth.

Fig. 1

PRISMA flow diagram of literature search and study selection. Note From Page et al. (2021)

Fig. 2

Risk of bias summary: review authors’ judgements about each risk of bias item for each included study

Fig. 3

Outcome 1: psychotherapy vs. non-active controls: change in anxiety symptoms at post-treatment

Fig. 4

Outcome 1: psychotherapy vs. non-active controls: change in anxiety symptoms at follow-up

Fig. 5

Outcome 1: CBT vs other type of psychotherapy: change in anxiety symptoms at post-treatment and at follow-up

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Outcome 2: psychotherapy vs. non-active controls: remission of primary anxiety disorder at post-treatment and follow-up

Fig. 7

Outcome 2: CBT vs other type of psychotherapy: remission of primary anxiety disorder at post-treatment and at follow-up

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Outcome 3: psychotherapy vs. non-active controls: change in depressive symptoms at post-treatment

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Outcome 3: psychotherapy vs. non-active controls: change in depressive symptoms at follow-up. Child report

Fig. 10

Outcome 3: CBT vs. other type of psychotherapy: change in depressive symptoms at post-treatment and follow-up

Fig. 11

Outcome 4: psychotherapy vs non-active control: remission of primary depressive disorder at post-treatment and follow-up