儿童和青少年抑郁症的社会心理疗法和综合疗法的最新证据基础。

IF 4.2 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Journal of Clinical Child and Adolescent Psychology Pub Date : 2024-11-04 DOI:10.1080/15374416.2024.2384022

V Robin Weersing, Pauline Goger, Karen T G Schwartz, Selena A Baca, Felix Angulo, Merissa Kado-Walton

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引用次数: 0

摘要

目的：本循证更新（EBU）建立在临床儿童与青少年心理学会（Society of Clinical Child and Adolescent Psychology）主办的前三次回顾（1998年、2008年、2017年）的基础上，旨在评估对青少年抑郁症进行心理干预的实证支持：在当前的回顾期内（2014-2022 年），共确定了 25 项随机对照试验 (RCT)：其中 4 项针对儿童，21 项针对青少年。针对主要结果计算了描述性效应大小和治疗所需人数（NNT）比。研究结果与之前的综述进行了整合，并利用累积的证据将治疗方法分为行之有效的、可能有效的、可能有效的或试验性的。对已发表的预测因子、调节因子和中介因子进行了二次分析：对于青少年而言，认知行为疗法（CBT）、人际心理疗法（IPT-A）、CBT 与抗抑郁药物治疗相结合以及协作护理计划均被列为行之有效的疗法。儿童方面的证据则要薄弱得多，没有一种治疗方法被列为有效或可能有效。新的进展包括更多地探索以父母和家庭为中介的治疗模式，以及越来越多的关于技术辅助干预的证据。有关预测因素、调节因素和中介因素的数据仍然集中在青少年抑郁样本上，并且来自数量有限的研究与治疗数据集：自上届 EBU 会议以来，青少年抑郁症治疗研究取得了逐步进展。目前迫切需要(a) 开发创新方法，以大幅提高大多数 RCT 中看到的微弱效果；(b) 扩大针对儿童和其他服务不足群体的证据基础；(c) 在确实存在多种有效治疗方法的情况下，制定基于证据的干预措施选择指南；(d) 解决治疗效果和可扩展性问题，以改善抑郁症在青少年中的广泛流行和高度影响。

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Evidence-Base Update of Psychosocial and Combination Treatments for Child and Adolescent Depression.

Objective: This evidence-based update (EBU) builds on three previous reviews (1998, 2008, 2017) sponsored by the Society of Clinical Child and Adolescent Psychology with the aim of evaluating the empirical support for psychosocial interventions for depression in youth.

Method: In the current review period (2014-2022), 25 randomized controlled trials (RCT) were identified: four in children and 21 in adolescents. Descriptive effect sizes and number-needed-to-treat (NNT) ratios were calculated for primary outcomes. Results were integrated with prior reviews, and cumulative evidence used to classify treatments as well-established, probably efficacious, possibly efficacious, or experimental. Published secondary analyses of predictors, moderators, and mediators were examined.

Results: For adolescents, cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT-A), CBT in combination with antidepressant medication, and collaborative care programs were all classified as well-established. The evidence was considerably weaker for children, with no treatments achieving well-established or probably efficacious status. New developments include greater exploration of parent- and family-mediated treatment models and increasing evidence on technology-assisted interventions. Data on predictors, moderators, and mediators continued to be focused on adolescent depression samples and drawn from a limited number of RCT datasets.

Conclusion: Since the prior EBU, there has been incremental progress in youth depression treatment research. There is an urgent need to: (a) develop innovative approaches to substantially improve on the modest effects seen in most RCTs, (b) expand the evidence base for children and other underserved groups, (c) craft evidence-based guidelines for choosing between interventions when multiple efficacious treatments do exist, and (d) address issues of treatment effectiveness and scalability to ameliorate the wide prevalence and high impact of depression in youth.

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来源期刊

Journal of Clinical Child and Adolescent Psychology Multiple-

CiteScore

9.70

自引率

4.80%

发文量

期刊介绍： The Journal of Clinical Child and Adolescent Psychology (JCCAP) is the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association. It publishes original contributions on the following topics: (a) the development and evaluation of assessment and intervention techniques for use with clinical child and adolescent populations; (b) the development and maintenance of clinical child and adolescent problems; (c) cross-cultural and sociodemographic issues that have a clear bearing on clinical child and adolescent psychology in terms of theory, research, or practice; and (d) training and professional practice in clinical child and adolescent psychology, as well as child advocacy.