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Cochrane Database of Systematic Reviews

Interventions for preventing relapse and recurrence of a depressive disorder in children and adolescents

Information

DOI:
https://doi.org/10.1002/14651858.CD007504.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 14 November 2012see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Common Mental Disorders Group

Copyright:
  1. Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Georgina R Cox

    Correspondence to: Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

    [email protected]

  • Caroline A Fisher

    Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

    Department of Clinical Neuropsychology, Austin Health, Heidelberg Repatriation Hospital, Heidelberg West, Australia

  • Stefanie De Silva

    Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

    headspace Centre of Excellence, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

  • Mark Phelan

    Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

  • Olaoluwa P Akinwale

    Public Health Division, Nigerian Institute of Medical Research, Yaba, Nigeria

  • Magenta B Simmons

    Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

    headspace Centre of Excellence, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

  • Sarah E Hetrick

    Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

    headspace Centre of Excellence, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

Contributions of authors

All authors contributed to the protocol development.

Georgina Cox screened trials for inclusion in the second search phase, extracted data for included trials, entered data for meta‐analysis and was involved in writing all sections of the review.

Sarah Hetrick co‐ordinated the development of the protocol, screened articles for inclusion and was involved in writing all sections of the review.

Magenta Simmons screened trials for inclusion.

Caroline Fisher, Stefanie De Silva, Olaoluwa Akinwale and Mark Phelan screened trials for inclusion and extracted data for the review.

Sources of support

Internal sources

  • Orygen Youth Health ‐ Research Centre. Melbourne, Australia.

External sources

  • No sources of support supplied

Declarations of interest

There are no declarations of interest for authors.

Acknowledgements

Many thanks to the CCDAN editorial team for ongoing support and advice.

Thanks to headspace Research Assistants Lauren Colautti and Alan Bailey for double‐checking all of the numerical data for the review and the characteristics of studies table.

Orygen Research Centre is thankful for the support of the Colonial Foundation.

Version history

Published

Title

Stage

Authors

Version

2012 Nov 14

Interventions for preventing relapse and recurrence of a depressive disorder in children and adolescents

Review

Georgina R Cox, Caroline A Fisher, Stefanie De Silva, Mark Phelan, Olaoluwa P Akinwale, Magenta B Simmons, Sarah E Hetrick

https://doi.org/10.1002/14651858.CD007504.pub2

2008 Oct 08

Interventions for preventing relapse and recurrence after the first episode of a depressive disorder in young people

Protocol

Nicholas Allen, Sarah E Hetrick, Marie B H Yap, Julian G Simmons

https://doi.org/10.1002/14651858.CD007504

Differences between protocol and review

In the protocol for this review, suicide‐related behaviour (both ideation and attempt) was specified as secondary outcome. However, due to the concern that taking antidepressant medications may potentially result in suicidal behaviour, we made a decision to include such behaviours as a primary outcome.

For dichotomous outcomes, such as 'number relapsed', results from each trial are expressed as an odds ratio (OR) with 95% confidence intervals and combined in meta‐analysis. Although the protocol for the review stipulated that we would express relapse rates as a risk ratio (RR), ORs have more favourable mathematical properties.

Originally we intended to perform subgroup analyses on trials that included children and adolescents versus those that included participants of any age who had experienced a first episode of depression. However, as the search did not yield any trials of the latter type, we could not perform this analysis. We also intended to perform subgroup analyses on trials that contained children versus those that contained adolescents, but the nature of the trials included in the review did not contain enough data to allow for this subgroup analysis.

During the review process it became apparent that within the two types of trial design that we had anticipated, there was considerable diversity. In trials where participants who had responded or remitted from an episode of MDD or DD during an acute phase of treatment were re‐randomised into a continuation or maintenance phase, re‐randomisation commonly occurred either early (after an acute phase) or late (after either a continuation and/or maintenance phase). Due to the variability in the length of treatment before re‐randomisation, we felt that it was important to perform subgroup analyses based on time of re‐randomisation (early or late).

Originally, we intended to undertake sensitivity analyses to assess the effect of risk of bias that may be introduced due to the decisions made in the process of undertaking the review. In psychiatry trials it is important to investigate the impact of assumptions made in various imputation methods used to account for missing data, such as analysis using LOCF and OC. However, as there were limited data contained in trials, we were unable to perform these analyses.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.