Evidence Scanty on Self-Care for Kids With Depression, Anxiety
By Anne Harding
NEW YORK—The effectiveness of the vast majority of self-care interventions suggested for children and young people with anxiety and depression has not been evaluated, new research shows.
"In our scoping review we found over 100 different self-care strategies reported as potentially helpful for children and young people with anxiety or depression, but in our systematic review we were only able to identify a handful as ever having been evaluated," Dr. Miranda Wolpert of University College London told Reuters Health by email.
"In the light of this physicians and others seeking to support self-care by young people with anxiety and depression should a) explore with those they work with which of the large range of self-care strategies they currently use; b) consider which self-care strategies might be appropriate to try going forward; and (crucially) c) support them to monitor and review the approaches they try out so that they can find out what works best for them," Dr. Wolpert added.
Addressing anxiety and depression in children and young people will likely require non-professionally mediated approaches to treatment, she and her colleagues write in The Lancet Psychiatry, online December 3. However, they note, most research on the effectiveness of these interventions in younger patients is on professionally mediated treatment.
"Any change that was not associated with a professional input has been termed spontaneous improvement rather than considering the effort or action of the individuals or the effect of other approaches that might have contributed to that improvement," the authors add.
"Since up to 48% of people with depression will show such spontaneous improvement, understanding more about what helped these individuals and how these approaches can be applied to others is important," they note.
Their scoping review identified 103 different non-professionally mediated approaches to treating depression in children and young people published from 2000 to 2018.
A subsequent systematic review found 38 studies meeting inclusion criteria, including 16 on cognitive and behavioral approaches, 10 on physical exercise, five on light therapy, three on dietary supplements, two on massage and one each on online peer support and contact with a dog.
There was evidence supporting light therapy for seasonal depression, and also evidence showing that attention bias modification-based digital interventions were not effective.
The evidence for computerized cognitive-behavioral therapy for depression and anxiety and exercise for depression was mixed.
"We used strict definitions of 'unguided or unsupported by a professional' and of having an existing mental health problem of anxiety or depression and of being under the age of 25 in our systematic review," Dr. Wolpert noted.
"This restricted the evidence available," she said. "For example, some of the lifestyle-related interventions, such as physical exercise, good nutrition, and massage, for which increasingly strong evidence for effectiveness in maintaining wellbeing and positive mental health is available, were therefore excluded. These might also be of use to those with emerging mental-health problems and clinicians should consider their relevance to their population."
Lancet Psychiatry 2018.
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