Efficacy and Acceptability of Cognitive Behavioral Therapy for Depression in Children: A Systematic Review and Meta-analysis



      Few meta-analyses have focused on the effect of cognitive behavioral therapy (CBT) for depression in children.

      Study Selection

      Randomized controlled trials comparing CBT with control conditions for depression in children (≤13 years old) were included.

      Data Sources

      Seven electronic databases (PubMed, Embase, CENTRAL, Web of Science, PsycINFO, CINAHL, and LiLACS) were searched from inception to September 2015.

      Data Extraction and Synthesis

      The primary efficacy was defined as mean change scores in depressive symptoms, and the second efficacy (remission) was a score below the threshold for a diagnosis of depression, both after treatment and at the end of follow-up. We also measured acceptability by the proportion of participants who discontinued treatment up to posttreatment.


      Nine studies with 306 participants were selected for this analysis. At posttreatment, CBT was significantly more effective than control conditions in terms of primary efficacy (standardized mean difference, −0.41; 95% confidence interval [CI], −0.64 to −0.18) and secondary efficacy (odds ratio [OR], 2.16; 95% CI, 1.24 to 3.78). At follow-up, the results were consistent with those of efficacy outcomes at posttreatment, with a standardized mean difference of −0.34 and an OR of 2.04. CBT had no statistical more all-cause discontinuations than the control group (OR, 0.69; 95% CI, 0.26 to 1.82). However, subgroup analyses found that CBT was only significantly more effective than nontreatment, while it was not better than wait list or psychological placebo.


      CBT seems to be more beneficial in the treatment of depression in children than nontreatment; however, this finding is limited by the small size of the trials and low literature quality.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jane Costello E.
        • Erkanli A.
        • Angold A.
        Is there an epidemic of child or adolescent depression?.
        J Child Psychol Psychiatry. 2006; 47: 1263-1271
        • Ryan N.D.
        • Puig-Antich J.
        • Ambrosini P.
        • et al.
        The clinical picture of major depression in children and adolescents.
        Arch Gen Psychiatry. 1987; 44: 854-861
        • Birmaher B.
        • Ryan N.D.
        • Williamson D.E.
        • et al.
        Childhood and adolescent depression: a review of the past 10 years. Part II.
        J Am Acad Child Adolesc Psychiatry. 1996; 35: 1575-1583
        • Philip H.
        Depression in children may go unnoticed and untreated.
        BMJ. 2002; 325: 229-230
        • Jonsson U.
        • Bohman H.
        • von Knorring L.
        • et al.
        Mental health outcome of long-term and episodic adolescent depression: 15-year follow-up of a community sample.
        J Affect Disord. 2011; 130: 395-404
        • Klein D.N.
        • Lewinsohn P.M.
        • Seeley J.R.
        Psychosocial characteristics of adolescents with a past history of dysthymic disorder: comparison with adolescents with past histories of major depressive and non-affective disorders, and never mentally ill controls.
        J Affect Disord. 1997; 42: 127-135
        • National Collaborating Centre for Mental Health
        Depression in Children and Young People: Identification and Management in Primary, Community and Secondary Care.
        British Psychological Society and Royal College of Psychiatrists, Leicester, UK2005
        • American Academy of Child and Adolescent Psychiatry
        Practice parameters for the assessment and treatment of children and adolescents with depressive disorders.
        J Am Acad Child Adolesc Psychiatry. 2007; 46: 1503-1526
      1. SBU. Treatment of depression. Stockholm: Swedish Council on Health Technology Assessment in Health Care (SBU); 2004. SBU report no 166/1 (in Swedish). Available at: Accessed September 20, 2015.

        • David-Ferdon C.
        • Kaslow N.J.
        Evidence-based psychosocial treatments for child and adolescent depression.
        J Clin Child Adolesc Psychol. 2008; 37: 62-104
        • Weisz J.R.
        • McCarty C.A.
        • Valeri S.M.
        Effects of psychotherapy for depression in children and adolescents: a meta-analysis.
        Psychol Bull. 2006; 132: 132-149
        • Watanabe N.
        • Hunot V.
        • Omori I.M.
        • et al.
        Psychotherapy for depression among children and adolescents: a systematic review.
        Acta Psychiatr Scand. 2007; 116: 84-95
        • Lewinsohn P.M.
        • Clarke G.N.
        • Hops H.
        • et al.
        Psychosocial treatments for adolescent depression.
        Clin Psychol Rev. 1999; 21: 385-401
        • Luby J.
        • Lenze S.
        • Tillman R.
        A novel early intervention for preschool depression: findings from a pilot randomized controlled trial.
        J Child Psychol Psychiatry. 2012; 53: 313-322
        • Zhou X.
        • Hetrick S.E.
        • Cuijpers P.
        • et al.
        Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: a systematic review and network meta-analysis.
        World Psychiatry. 2015; 14: 207-222
        • Hamilton M.
        A rating scale for depression.
        J Neurol Neurosurg Psychiatry. 1960; 23: 56-62
        • Kovacs M.
        The Children's Depression Inventory (CDI).
        Psychopharmacol Bull. 1985; 21: 995-998
        • Beck A.T.
        • Steer R.
        Beck Depression Inventory: Manual.
        Psychological Corporation, San Antonio, Tex1987
      2. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. Updated March 2011. Available at: Accessed September 21, 2015.

        • Egger M.
        • Davey Smith G.
        • Schneider M.
        • et al.
        Bias in meta-analysis detected by a simple, graphical test.
        BMJ. 1997; 315: 629-634
        • Asarnow J.R.
        • Scott C.V.
        • Mintz J.
        A combined cognitive-behavioral family education intervention for depression in children: a treatment development study.
        Cogn Ther Res. 2002; 26: 221-229
        • Butler L.
        • Miezitis S.
        • Friedman R.
        • et al.
        The effect of two school-based intervention programs on depressive symptoms in preadolescents.
        Am Educ Res J. 1980; 17: 111-119
        • Dana E.C.
        A Cognitive–Behavioral Intervention for Conduct Disordered and Concurrently Conduct Disordered and Depressed Children [dissertation].
        Adelphi University, Garden City, NY1998
        • De Cuyper S.
        • Timbremont B.
        • Braet C.
        • et al.
        Treating depressive symptoms in schoolchildren: a pilot study.
        Eur Child Adolesc Psychiatry. 2004; 13: 105-114
        • Liddle B.
        • Spence S.H.
        Cognitive-behaviour therapy with depressed primary school children: a cautionary note.
        Behav Psychother. 1990; 18: 85-102
        • Reivich K.
        The Prevention of Depressive Symptoms in Adolescents.
        ([dissertation]) University of Pennsylvania, Philadelphia, Pa1996
        • Roberts C.
        • Kane R.
        • Thomson H.
        • et al.
        The prevention of depressive symptoms in rural school children: a randomized controlled trial.
        J Consult Clin Psychol. 2003; 71: 622-628
        • Stark K.D.
        • Reynolds W.M.
        • Kaslow N.J.
        A comparison of the relative efficacy of self-control therapy and a behavioral problem-solving therapy for depression in children.
        J Abnorm Child Psychol. 1987; 15: 91-113
        • Weisz J.R.
        • Thurber C.A.
        • Sweeney L.
        • et al.
        Brief treatment of mild-to-moderate child depression using primary and secondary control enhancement training.
        J Consult Clin Psychol. 1997; 65: 703-707
        • Arnberg A.
        • Öst L.G.
        CBT for children with depressive symptoms: a meta-analysis.
        Cogn Behav Ther. 2014; 43: 275-288
        • Vostanis P.
        • Feehan C.
        • Grattan E.
        • et al.
        A randomised controlled out-patient trial of cognitive-behavioural treatment for children and adolescents with depression: 9-month follow-up.
        J Affect Disord. 1996; 40: 105-116
        • Fristad M.A.
        • Verducci J.S.
        • Walters K.
        • et al.
        Impact of multifamily psychoeducational psychotherapy in treating children aged 8 to 12 years with mood disorders.
        Arch Gen Psychiatry. 2009; 66: 1013-1021
        • Hróbjartsson A.
        • Gøtzsche P.C.
        Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment.
        N Engl J Med. 2001; 344: 1594-1602
        • Ma D.
        • Zhang Z.
        • Zhang X.
        • et al.
        Comparative efficacy, acceptability, and safety of medicinal, cognitive-behavioral therapy, and placebo treatments for acute major depressive disorder in children and adolescents: a multiple-treatments meta-analysis.
        Curr Med Res Opin. 2014; 30: 971-995
        • Weersing V.R.
        • Brent D.A.
        Cognitive behavioral therapy for depression in youth.
        Child Adolesc Psychiatr Clin N Am. 2006; 15 (ix): 939-957
        • Zhou X.
        • Qin B.
        • Del Giovane C.
        • et al.
        Efficacy and tolerability of antidepressants in the treatment of adolescents and young adults with depression and substance use disorders: a systematic review and meta-analysis.
        Addiction. 2015; 110: 38-48
        • Rohde P.
        • Clarke G.N.
        • Lewinsohn P.M.
        • et al.
        Impact of comorbidity on a cognitive-behavioral group treatment for adolescent depression.
        J Am Acad Child Adolesc Psychiatry. 2001; 40: 795-802
        • Hudson J.L.
        • Comer J.S.
        • Kendall P.C.
        Parental responses to positive and negative emotions in anxious and nonanxious children.
        J Clin Child Adolesc Psychol. 2008; 37: 303-313
        • Compton S.N.
        • March J.S.
        • Brent D.
        • et al.
        Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: an evidence-based medicine review.
        J Am Acad Child Adolesc Psychiatry. 2004; 43: 930-959
        • Michael K.D.
        • Crowley S.L.
        How effective are treatments for child and adolescent depression? A meta-analytic review.
        Clin Psychol Rev. 2002; 22: 247-269