Effectiveness of family‐based therapy for depressive symptoms in children and adolescents: A systematic review and meta‐analysis

Abstract

Early‐onset depression contributes significantly to the global health burden and has long‐term negative effects. This meta‐analysis collates and examines the effectiveness of family‐based interventions, where family members are involved in the treatment of depression in children and adolescents. A literature search was performed up to 8th March 2023. Randomised controlled trials of family‐based interventions were included for participants aged 3–18 years with a diagnosis of major depressive disorder or dysthymia, according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM‐5; American Psychiatric Association, 2013) or with a score above a cut‐off on a standardised self‐report depression measure. The overall effect size for treatment versus active control was g = 0.22 (95% confidence interval [CI]: −0.05–0.50) (nine studies; 659 participants), and for treatment versus non‐active control it was g = 0.46 (95% CI: −0.09–1.01) (four studies; 385 participants). Effect sizes were not statistically significant, and heterogeneity was high, ranging between I2 = 64.3–81.1%. Subgroup analysis comparing attachment‐based family therapy with family therapy using other theoretical frameworks did not yield a significant difference between the two. The effects of family‐based therapies were larger than those in the comparison groups, but family‐based therapy did not demonstrate a significant treatment benefit compared to the controls. More randomised controlled trials are warranted, considering that evidence for other psychotherapies for depression in children and adolescents, indicates modest effects. Family‐based therapy may be an alternative for children and adolescents whose needs are not addressed by these treatments.