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Systematic Review and Meta-Analysis: Outcomes of Routine Specialist Mental Health Care for Young People With Depression and/or Anxiety

Bear, HA; Edbrooke-Childs, J; Norton, S; Krause, KR; Wolpert, M; (2019) Systematic Review and Meta-Analysis: Outcomes of Routine Specialist Mental Health Care for Young People With Depression and/or Anxiety. Journal of the American Academy of Child & Adolescent Psychiatry 10.1016/j.jaac.2019.12.002. (In press).

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Abstract

Objective: Depression and anxiety are the most prevalent mental health problems in youth, yet almost nothing is known about what outcomes are to be expected at the individual level following routine treatment. This paper sets out to address this gap by undertaking a systematic review of outcomes following treatment as usual (TAU) with a particular focus on individual-level outcomes. / Method: MEDLINE, Embase and PsycInfo were searched for articles published between 1980 and January 2019 that assessed TAU outcomes for youth depression and anxiety accessing specialist mental healthcare. Meta-analysis considered change at both group-level pre-post effect size (ES) and individual-level recovery, reliable change and reliable recovery. Temporal analysis considered stability of primary and secondary outcomes over time. Sub-group analysis considered the moderating effect of informant; presenting problem; study design; study year; mean age of youth; use of medication; intervention dosage and type of treatment offered on outcomes. A protocol was pre-registered on PROSPERO (CRD42017063914). / Results: Initial screening of 6,350 publications resulted in 38 which met the inclusion criteria, and which were subsequently included in meta-analyses. This resulted in a final full pooled sample of 11,739 young people (61% of which were female, mean age 13.8 years). The pre-post ES (Hedges’ g) at first/final outcome (13/ 26 weeks) was -0.74/- 0.87. The individual-level change on measures of self-report was 38% reliable improvement, 44% no reliable change and 6% reliable deterioration. Outcomes varied according to moderators, informant, problem type and dosage. / Conclusion: Poor data quantity and quality are limitations, but this is the first study that indicates likely rates of reliable improvement for those accessing TAU. We propose the need for improved reporting of both individual-level metrics and details of TAU to enable greater understanding of likely current outcomes from routine care for youth with depression and anxiety in order to allow the potential for further improvement of impact.

Type: Article
Title: Systematic Review and Meta-Analysis: Outcomes of Routine Specialist Mental Health Care for Young People With Depression and/or Anxiety
Location: United States
DOI: 10.1016/j.jaac.2019.12.002
Publisher version: https://doi.org/10.1016/j.jaac.2019.12.002
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: anxiety, children, depression, treatment outcome, usual care, young people
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Clinical, Edu and Hlth Psychology
URI: https://discovery.ucl.ac.uk/id/eprint/10090020
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