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Family Therapy Not Superior to Other Therapies for Adolescents With Depression

Suicidal ideation showed a significant effect in favor of family therapy compared to comparison therapy.

Family therapy was not necessarily more beneficial than other comparison therapies in treating pediatric patients with depression or suicidal ideation.

A team, led by Luxsiya Waraan, PhD, Division of Mental Health Services, Akershus University Hospital, analyzed the effectiveness of family therapy compared to other active treatments for pediatric patients with depressive disorders or suicidal ideation.

Current Guidelines

Currently, pediatric patients with depression are treated with either antidepressants, some form of psychotherapy, or a combination of both. Most guidelines call for cognitive-behavioral therapy as a first line evidence based intervention for adolescent patients with depression.

“Although CBT has a strong evidence base for bein effective, several meta-analyses have shown that effect sizes are small to moderate,” the authors wrote. “Interpersonal psychotherapy (IPT) has in later years been shown to be equally effective as CBT or even more effective in some studies.”

The Review

In the systematically review and meta-analyze, the investigators searched various databases and for outcomes of depressive symptoms and suicidal ideation in an effort to fill the gaps on missing systematic reviews and meta-analysis of family therapy for this patient population.

The team reviewed clinical trials with family therapy for depression and/or suicidal ideation in adolescents, examined the effectiveness of family therapy in reducing depressive symptoms and suicidal ideation compared to other treatments, and evaluated their methodological quality.

The studies included in the final analysis involved patients aged 9-18 years who met the diagnostic criteria for a depressive disorder, according to a structured diagnostic interview or exceeded a predefined threshold for depressive symptoms in a standardized assessment or reported suicidal ideation, using a validated symptom measure.

The investigators sought primary outcomes of the differential change in level of depressive symptoms or suicidal ideation following treatment between family therapy and comparison groups.

Screening the Studies

Overall they screened 5940 records and identified 10 randomized controlled studies of family therapy for depressive disorder or suicidal ideation in adolescents with an active treatment comparison group.

There were 9 studies included that reported outcome measures of depressive symptoms and 4 studies reporting outcome measures of suicidal ideation.

The investigators found no significant difference between family therapy and active comparison treatment for end-of-treatment levels of depression.

The analysis of suicidal ideation showed a significant effect in favor of family therapy compared to comparison therapy.

“Based on the current body of research, we found that family therapy is not superior to other psychotherapies in the treatment of depressive disorder,” the authors wrote. “However, family therapy leads to significantly improved outcomes for suicidal ideation, compared to other psychotherapies. The evidence for the treatment of depression is of low quality needs more research.”

The study, “Family therapy for adolescents with depression and suicidal ideation: A systematic review and meta–analysis,” was published online in Clinical Child Psychology and Psychiatry.