Meta-Analysis: Relapse Prevention Strategies for Depression and Anxiety in Remitted Adolescents and Young Adults

Suzanne J Robberegt; Marlies E Brouwer; Bas E A M Kooiman; Yvonne A J Stikkelbroek; Maaike H Nauta; Claudi L H Bockting

doi:10.1016/j.jaac.2022.04.014

Meta-Analysis: Relapse Prevention Strategies for Depression and Anxiety in Remitted Adolescents and Young Adults

J Am Acad Child Adolesc Psychiatry. 2023 Mar;62(3):306-317. doi: 10.1016/j.jaac.2022.04.014. Epub 2022 May 2.

Authors

Suzanne J Robberegt¹, Marlies E Brouwer², Bas E A M Kooiman³, Yvonne A J Stikkelbroek⁴, Maaike H Nauta⁵, Claudi L H Bockting⁶

Affiliations

¹ Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Depression Expertise Centre-Youth, GGZ Oost Brabant, the Netherlands.
² Amsterdam University Medical Centers, University of Amsterdam, the Netherlands.
³ Depression Expertise Centre-Youth, GGZ Oost Brabant, the Netherlands; University of Groningen, the Netherlands.
⁴ Depression Expertise Centre-Youth, GGZ Oost Brabant, the Netherlands; Utrecht University, the Netherlands.
⁵ University of Groningen, the Netherlands; Accare Child Study Centre, the Netherlands.
⁶ Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, the Netherlands. Electronic address: c.l.bockting@amsterdamumc.nl.

PMID: 35513189
DOI: 10.1016/j.jaac.2022.04.014

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.

Keywords: anxiety disorders; depressive disorders; intervention; meta-analysis; relapse prevention.

Publication types

Meta-Analysis

MeSH terms

Adolescent
Adult
Antidepressive Agents
Anxiety / therapy
Depression* / therapy
Humans
Psychotherapy* / methods
Recurrence
Secondary Prevention
Young Adult

Substances

Antidepressive Agents