Date of Award:

5-1999

Document Type:

Dissertation

Degree Name:

Doctor of Philosophy (PhD)

Department:

Psychology

Committee Chair(s)

Susan L. Crowley

Committee

Susan L. Crowley

Committee

David Stein

Committee

Pat Truhn

Committee

Tamara Ferguson

Committee

Dennis Odell

Abstract

Prevalence estimates of child depression are substantial and morbidity leads to an increased risk of recurrence during adolescence and adulthood. Further, early-onset depression is associated with a number of negative outcomes including: poor physical health, social and interpersonal impairments, academic problems, substance abuse, future maladjustment, and suicidal behavior. In light of the prevalence, persistence, and negative outcomes associated with depression in children and adolescents, several treatments ranging from psychosocial to pharmacological interventions have been developed and evaluated. However, the overall efficacy of treatments remains equivocal because the majority of existing reviews of the child and adolescent depression treatment literature are narrative in nature, methodologically flawed, and/or present vague or conflicting conclusions. Although there are a number of good meta-analytic reviews that indicate that psychotherapy is effective with children and adolescents overall, comprehensive meta-analytic reviews focusing on the efficacy of psychological treatments specifically for depressed youth are nonexistent in the published literature.

A comprehensive sample of studies on the psychosocial and pharmacological treatment of early-onset depression was located through an extensive literature search. Articles that met the inclusionary criteria were subsequently analyzed. The outcome data from 37 outcome studies were extracted and converted into effect sizes. Comparisons of main effects, potential interactions, and other specified variables were conducted. The overall findings of this meta-analysis indicate that several different psychosocial interventions for early-onset depression produce moderate to large treatment gains that are clinically meaningful for many afflicted youth. Further, it appears that psychosocial treatments are, in general, superior to pharmacological regimens in treating depressed children and adolescents. However, there is also recent evidence that selective serotonin reuptake inhibitors such as fluoxetine are efficacious, and they will likely play an increased role in the management of affective illness in youngsters. The clinical implications and limitations of these data are discussed and suggestions for future research are provided

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