Counseling Outcomes From 1990 to 2008 for School‐Age Youth With Depression: A Meta‐Analysis

Depression is a mood state that involves frequent and intense feelings of sadness that cause an individual to lose interest in normal daily activities, such as work or school performance, social relationships, or normally pleasurable activities (American Psychiatric Association, 2000). Although depressive disorders are often thought of as affecting adults, it is not at all rare to encounter school-age youth with depression or depressive features (Imel, Malterer, McKay, & Wampold, 2008). Estimates of the prevalence of depression in school-age youth are approximately 2% to 3% for prepubertal children and 5% to 8% for adolescents (Birmaher et al., 1996; Costello et al., 1996; Costello, Erkanli, & Angold, 2006; Lewinsohn, Clarke, Seeley, & Rohde, 1994). By the age of 18, nearly 20% to 25% of youth will have met criteria for major depressive disorder at least once (Birmaher et al., 1996; Clarke et al., 2001; Lewinsohn et al., 1994), and Ryan (2005) estimated that clinically relevant symptoms can be observed in up to 30% of adolescents. Many youth with depression continue to experience depression as adults. Depression has been shown to affect social functioning, academic performance, family relationships, use of mental health services, drug use, suicide, and prevalence of other psychiatric disorders (Angold & Costello, 1993; Birmaher et al., 1996; Clarke, DeBar, & Lewinsohn, 2003; Gould et al., 1998; Le, Munoz, Ippen, & Stoddard, 2003; Stolberg, Clark, & Bongar, 2002). In empirical studies, depression is usually operationalized quantitatively as an elevated score on a self-report or other-report depression scale (Nemeroff, 2007). Therefore, levels of depression can be measured with reasonable accuracy, and the effectiveness of treatments meant to reduce symptoms of depression can be assessed. Counseling/psychotherapy and antidepressant medications are the two most common treatments for depression in youth. Clinical trials and synthesized meta-analyses of the use of medication for the treatment of depression have yielded mixed results. Some studies indicated that medication had a small but significant advantage over psychotherapy in posttest and follow-up studies (Imel et al., 2008). Other studies concluded that neither approach yielded superior treatment outcomes over the other (De Maat, Dekker, Schoevers, & De Jonghe, 2006; Hazell, O'Connell, Heathcote, & Henry, 2002). What is clear is that concerns exist over the increased risks of suicide and suicidal ideation when using antidepressant medications with youth, and these concerns have resulted in the issuance of safety warnings (Costello et al., 2002; Vitiello & Swedo, 2004; Whittington et al., 2004). As a result, in the United Kingdom, the National Institute of Clinical Excellence recommended psychotherapy as preferable to medication in initial attempts to treat depression in youth (Ramchandani, 2004). A similar recommendation was made by the American Academy of Child and Adolescent Psychiatry (AACAP; 1998) for the treatment of depression in school-age youth in the United States. If counseling or psychotherapy is the first avenue for treatment of depression in school-age youth, counselors and psychotherapists need answers to several important questions about the effectiveness of this broad therapeutic approach, and the following three questions form the purpose of this meta-analysis: (a) Is counseling/psychotherapy effective in reducing symptoms of depression in school-age youth when compared with various comparison conditions? (b) Do the effects of counseling/psychotherapy last? and (c) Is there a differential effectiveness when treatment of depression in youth is conducted in school settings as opposed to clinic/outpatient conditions? * Is Counseling/Psychotherapy Effective for School-Age Youth With Depression? The primary question of this meta-analysis involves whether counseling and psychotherapy are effective in reducing symptoms of depression in school-age youth when compared with various control or comparison conditions. …