Meta-Analysis: Relapse Prevention Strategies for Depression and Anxiety in Remitted Adolescents and Young Adults - 24/02/23
Abstract |
Objective |
Depression and anxiety cause a high burden of disease and have high relapse rates (39%-72%). This meta-analysis systematically examined effectiveness of relapse prevention strategies on risk of and time to relapse in youth who remitted.
Method |
PubMed, PsycInfo, Embase, Cochrane, and ERIC databases were searched up to June 15, 2021. Eligible studies compared relapse prevention strategies to control conditions among youth (mean age 13-25 years) who were previously depressed or anxious or with ≥30% improvement in symptoms. Two reviewers independently assessed titles, abstracts, and full texts; extracted study data; and assessed risk of bias and overall strength of evidence. Random-effects models were used to pool results, and mixed-effects models were used for subgroup analyses. Main outcome was relapse rate at last follow-up (PROSPERO ID: CRD42020149326).
Results |
Of 10 randomized controlled trials (RCTs) that examined depression, 9 were eligible for analysis: 4 included psychological interventions (n = 370), 3 included antidepressants (n = 80), and 2 included combinations (n = 132). No RCTs for anxiety were identified. Over 6 to 75 months, relapse was half as likely following psychological treatment compared with care as usual conditions (k = 6; odds ratio 0.56, 95% CI 0.31 to 1.00). Sensitivity analyses including only studies with ≥50 participants (k = 3), showed similar results. Over 6 to 12 months, relapse was less likely in youth receiving antidepressants compared with youth receiving pill placebo (k = 3; OR 0.29, 95% CI 0.10 to 0.82). Quality of studies was suboptimal.
Conclusion |
Relapse prevention strategies for youth depression reduce risk of relapse, although adequately powered, high-quality RCTs are needed. This finding, together with the lack of RCTs on anxiety, underscores the need to examine relapse prevention in youth facing these common mental health conditions.
Le texte complet de cet article est disponible en PDF.Key words : anxiety disorders, depressive disorders, intervention, meta-analysis, relapse prevention
Plan
| This work was supported by a grant from the Netherlands Organization for Health Research and Development (636310007), GGZ Oost Brabant, Accare, RINO Zuid, and the University of Groningen. The Netherlands Organization for Health Research and Development, GGZ Oost Brabant, Accare, RINO Zuid, and the University of Groningen had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. |
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| This work has been prospectively registered: display_record.php?ID=CRD42020149326. |
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| Author Contributions |
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| Conceptualization: Robberegt, Brouwer, Kooiman, Stikkelbroek, Nauta, Bockting |
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| Data curation: Robberegt, Brouwer, Bockting |
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| Formal analysis: Robberegt, Brouwer |
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| Funding acquisition: Stikkelbroek, Nauta, Bockting |
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| Investigation: Robberegt, Brouwer, Kooiman, Nauta |
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| Methodology: Robberegt, Brouwer, Kooiman, Stikkelbroek, Nauta, Bockting |
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| Project administration: Robberegt, Brouwer, Bockting |
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| Resources: Brouwer, Bockting |
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| Software: Robberegt, Brouwer |
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| Supervision: Brouwer, Stikkelbroek, Nauta, Bockting |
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| Validation: Robberegt, Brouwer, Kooiman |
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| Visualization: Robberegt, Brouwer |
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| Writing – original draft: Robberegt, Brouwer, Bockting |
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| Writing – review and editing: Robberegt, Brouwer, Kooiman, Stikkelbroek, Nauta, Bockting |
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| The authors wish to thank Celine Breurken, MSc, and Rosa Joosten, MSc, of GGZ Oost Brabant, Tritia van der Velde, BSc, and Hedwich Boelens, BSc, of the University of Groningen, and Romy Stuik, BSc, of the University of Amsterdam, for assistance in screening and selecting articles, data extraction, and risk of bias assessments. |
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| Disclosure: Dr. Stikkelbroek, Profs. Nauta and Bockting, Ms. Robberegt, and Mr. Kooiman have reported they are co-developers of the StayFine app, a personalized guided app-based relapse prevention intervention for remitted youth with a history of depressive or anxiety disorders. The StayFine app is based on preventive cognitive therapy of Prof. Bockting. Dr. Brouwer has reported no biomedical financial interests or potential conflicts of interest. |
Vol 62 - N° 3
P. 306-317 - mars 2023 Retour au numéro
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