Effectiveness of interventions for anxiety and depression in children: an umbrella review of meta-analyses

BackgroundAnxiety and depression are the most common mental health conditions for children and young people (CYP). However, recommendations for treatment approaches vary. We aimed to identify the most effective interventions for treating CYP with anxiety and depression through an umbrella synthesis of recent literature.MethodsFor this umbrella review (meta-analysis of meta-analyses) we conducted a search of five electronic databases (PubMed, Medline, PsycInfo, Web of Science, ASSIA) from 1 October 2017 to 1 October 2022. Eligible meta-analyses reported on interventions for CYP (≤18 years) with anxiety or depression and/or associated symptoms; prevention or risk studies were excluded. Summary data were manually extracted, and standardized effect sizes (Cohen’s d) were compared across interventions at different levels of specificity.FindingsWe identified 42 meta-analyses (520 effect sizes); of these, 37 meta-analyses (378 effects) were included in statistical analyses. For anxiety, psychosocial (d = -0.52, 95% confidence interval (CI) [-0.57, -0.47], p < 0.001) and pharmacological interventions (d = -0.60, 95% CI [-0.75, -0.45], p < 0.001) were equally effective (t(17.00) = -1.58, p = 0.133). For depression, physical (d = -0.50, CI [-0.61, -0.39], p < 0.001) and psychosocial (d = -0.35, CI [-0.39, -0.32], p < 0.001) interventions were most effective, followed by pharmacological (d = -0.17, CI [-0.20, -0.15], p < 0.001), (F(2, 32.3) = 41.0, p < 0.001). Most interventions were more effective at treating CYP with anxiety than depression, including psychosocial (MD = -0.17, CI [-0.24, -0.09], t(295.29) = -4.29, p < 0.001) and pharmacological interventions (MD = -0.66, CI [-1.04, -0.28], t(16.23) = -3.65, p = 0.002).InterpretationIn addition to psychosocial therapies, pharmacological interventions could be a first-line treatment for CYP with anxiety. The effectiveness of physical interventions for depression is a significant emerging finding, as is the comparatively limited effectiveness of pharmacological treatments; both should be reflected in practice guidelines. Future research should focus on understanding, developing, and providing more effective interventions for CYP with depression.FundingGates Cambridge Trust [#OPP1144].