Review: The effectiveness of interpersonal psychotherapy for adolescents with depression – a systematic review and meta‐analysis

Abstract

Background Interpersonal psychotherapy for adolescents (IPT‐A) is a manualised, time‐limited intervention for young people with depression. This systematic review aimed to determine the effectiveness of IPT‐A for treating adolescent depression. Method A systematic search of relevant electronic databases and study reference lists was conducted. Any study investigating the effectiveness of IPT‐A in 12‐ to 20‐year‐olds with a depressive disorder was eligible. Synthesis was via narrative summary and meta‐analysis. Results Twenty studies were identified (10 randomised trials and 10 open trials/case studies), many of which had small sample sizes and were of varying quality. Following IPT‐A, participants experienced large improvements in depression symptoms (d = −1.48, p < .0001, k = 17), interpersonal difficulties with a medium effect (d = −0.68, p < .001, k = 8) and in general functioning with a very large effect (d = 2.85, p < .001, k = 8). When compared against control interventions, IPT‐A was more effective than non‐CBT active controls in reducing depression symptoms (d = −0.64, p < .001, k = 5) and was no different from CBT (d = 0.05, p = .88, k = 2). There was no difference between IPT‐A and active control interventions in reducing interpersonal difficulties (d = −0.26, p = .25, k = 5). Conclusions Interpersonal psychotherapy for adolescents is an effective intervention for adolescent depression, improving a range of relevant outcomes. IPT‐A is consistently superior to less structured interventions and performs similarly to CBT. However, these conclusions are cautious, as they are based on a small number of controlled studies, with minor adaptations to the standard IPT‐A protocol, and/or were conducted by the intervention developers. Further robust RCTs are therefore required. The lack of superiority in IPT‐A for improving interpersonal difficulties highlights a need for studies to explore the underpinning mechanisms of change.

Facilitating improvements in young people’s social relationships to prevent or treat depression: A review of empirically supported interventions

“…Further evidence suggests that IPT-A is well suited and acceptable to young people. Meta-analyses show that IPT-A is associated with significantly fewer dropouts than IPT for adults (13.0 vs. 22.6%) 73 , and is either superior or non-inferior to active and non-active controls in terms of its all-cause discontinuation rate 67 , 70 , 71 . Although IPT-A trials have been predominantly conducted in the United States ( k = 14), efficacy is also supported in low socioeconomic groups 74 , and in samples from Australia ( k = 1), Canada ( k = 1), Puerto Rico ( k = 2), Uganda ( k = 1) and Taiwan ( k = 1) 67 .…”

“…Meta-analyses show that IPT-A is associated with significantly fewer dropouts than IPT for adults (13.0 vs. 22.6%) 73 , and is either superior or non-inferior to active and non-active controls in terms of its all-cause discontinuation rate 67 , 70 , 71 . Although IPT-A trials have been predominantly conducted in the United States ( k = 14), efficacy is also supported in low socioeconomic groups 74 , and in samples from Australia ( k = 1), Canada ( k = 1), Puerto Rico ( k = 2), Uganda ( k = 1) and Taiwan ( k = 1) 67 . IPT-A has also been successfully implemented in community-based settings with internally trained school-based mental health professionals, where strongest treatment effects were observed for older adolescents (15–18 vs. 12–14 years) and those with greater severity of depressive symptoms at baseline 75 .…”

“…Another meta-analysis of 20 IPT-A studies for 12–20 year olds ( N = 910) showed large improvements in depressive symptoms post-intervention ( d = 1.48) and through follow-up (20–52 weeks; d = 1.2) 67 . It also showed moderate and very large improvements in interpersonal functioning ( d = 0.68), and general functioning ( d = 2.85), respectively.…”

“…The efficacy of IPT-A is supported by multiple meta-analyses 67 – 71 . These meta-analyses report on different outcomes, but it is important to acknowledge the overlap of included studies across them (i.e., of the five meta-analyses reported on below, 22 studies were included in total and 12 were included in more than one meta-analysis).…”

Editorial: The job of an editor—one year on

“…Moving on to adolescent depression, Orchard, Pass, Cocks, Chessell, and Reynolds () demonstrate that there is a low agreement between the young people’s and the parents’ report of symptoms of depression and that where discrepancies exist, young people’s reports should be taken seriously. Moving from detection to treatment, the most comprehensive meta‐analysis of Interpersonal Psychotherapy for Adolescents (IPT‐A) to date (Duffy, Sharpe, & Schwannauer, ) strengthens the evidence for IPT‐A as a good choice for adolescents with depression, whilst pointing out important gaps, particularly the need to understand the mechanisms of change in psychological treatments. Finally, we look at the experiences of young people and their carers during the challenging time of moving from child and adolescent to adult services (Hill, Wilde, & Tickle, ).…”