Psychotherapy for Depression in Children and Adolescents: Study Protocol for a Systematic Review and Network Meta-Analysis

Introduction: Depression is common among children and adolescents and is associated with significantly negative effects. A number of structured psychosocial treatments are administered for depression in children and adolescents; however, evidence of their effectiveness is not clear. We describe the protocol of a systematic review and network meta-analysis to evaluate the efficacy, quality of life, tolerability, and acceptability of the use of psychological intervention for this young population. Methods and analysis: We will search PubMed, EMBASE, CENTRAL (the Cochrane Central Register of Controlled Trials), Web of Science, PsycINFO, CINAHL, LiLACS, Dissertation Abstracts, European Association for Grey Literature Exploitation [EAGLE], and the National Technical Information Service [NTIS] from inception to July 2014. There will be no restrictions on language, publication year, or publication type. Only randomized clinical trials (RCTs) with psychosocial treatments for depression in children and adolescents will be considered. The primary outcome of efficacy will be the mean overall change of the total score in continuous depression severity scales from baseline to endpoint. Data will be independently extracted by two reviewers. Traditional pairwise meta–analyses will be performed for studies that directly compared different treatment arms. Then, we will perform a Bayesian network meta–analyses to compare the relative efficacy, quality of life, tolerability, and acceptability of different psychological intervention. Subgroup analyses will be performed by the age of participants and the duration of psychotherapy, and sensitivity analyses will be conducted to assess the robustness of the findings. Ethics and dissemination: No ethical issues are foreseen. The results will be published in a peer–reviewed journal and will be disseminated electronically and in print. The meta–analysis may be updated to inform and guide management of depression in children and adolescents. Registration: PROSPERO CRD42014010014. Strengths and limitations of this study 1. This Bayesian network meta-analysis can integrate direct evidence with indirect evidence from multiple treatment comparisons to estimate the interrelations across all treatments. 2. We will comprehensively assess the efficacy, quality of life, tolerability, acceptability, and suicide-related outcomes in acute treatment and follow-up. 3. A series of subgroup and sensitivity analyses will address clinically relevant questions. 4. This study should help guide clinical decision-making of psychotherapeutic interventions to better treat child and adolescent depression.