Table 2Evidence profile & quality assessment of trials comparing group CBT with waitlist control/‘standard care’/no treatment

No. of studiesQuality assessmentSummary of findings
DesignQualityConsistencyDirectnessOther modifying factorsNo. of patientsEffectClinical interpretation of the effect*Quality of evidence (high, moderate, low, very low)
Group CBTControlRelative (95% CI)AUC (95% CI)
Group CBT vs. waitlist control/‘standard care’/no treatment
Remission - endpoint
Clinician completed
Remission (DSM criteria at end of treatment)
LEWINSOHN1990
CLARKE1999
CLARKE2002
RCTBlinding not consistently reportedNo important inconsistencyAge: 13-18Imprecise data110107RR 0.78 (0.62 to 0.98)AUC 57% (51 to 64)InconclusiveLow
Self report
Remission (DSM criteria at end of treatment)
REYNOLDS1986
WEISZ1997
LEWINSOHN1990
RCTBlinding not consistently reportedKAHN1990 removed due to heterogeneityAge: 10-184661RR 0.57 (0.42 to 0.76)AUC 70% (62 to 78)Evidence of benefitModerate
Remission (RADS at end of treatment)
KAHN1990RCTOnly half of raters blindNot applicableAge: 10-14Sparse data1717RR 0.13 (0.04 to 0.50)AUC 88% (77 to 99)Evidence of benefitLow
Remission - follow up
Clinician completed
Remission (DSM criteria at 12 months follow-up)
CLARKE2002RCTNo serious limitationsNot applicableAge: 13-18Imprecise data3645RR 1.56 (0.69 to 3.55)AUC 45% (36 to 54)Evidence of no differenceModerate
Remission (DSM criteria at 24 months follow-up)
CLARKE2002RCTNo serious limitationsNot applicableAge: 13-18Imprecise data3242RR 1.31 (0.28 to 6.08)AUC 49% (43 to 56)Evidence of no differenceModerate
Depressive symptoms - endpoint
Clinician completed
CDRS-R/HDRS mean depression scores
CLARKE1999
WEISZ1997
CLARKE2002
RCTBlinding not consistently reportedNo important inconsistencyAge: 14-18Imprecise data91106SMD -0.30 (-0.59 to -0.01)AUC 58% (50 to 66)InconclusiveLow
BID Mean depression scores
KAHN1990RCTOnly half of raters blindNot applicableAge: 10-14Sparse data1717SMD − 1.00 (-1.72 to -0.28)AUC 76% (58 to 89)Limited evidence of benefitLow
Self report
BDI/CDI
KAHN1990
LEWINSOHN1990
CLARKE1999
WEISZ1991
RCTBlinding not consistently reportedNo important inconsistencyAge: 10-189195SMD -0.82 (-1.12 to -0.51)AUC 72% (64 to 79)Evidence of benefitModerate
RADS/CES-D Mean depression scores
KAHN1990
LEWINSOHN1990
CLARKE2002
RCTBlinding not consistently reportedI2 = 86.2%Age: 10-187683Random Effects SMD − 1.02 (-2.00 to -0.04)AUC 76% (51 to 92)Limited evidence of benefitModerate
Depressive symptoms - follow up
Clinician completed
HDRS mean depression scores at 12 month follow-up
CLARKE2002RCTNo serious limitationsNot applicableAge: 13-18Sparse data3645SMD 0.21 (-0.23 to 0.65)AUC 44% (32 to 56)Evidence of no differenceModerate
HDRS mean depression scores at 24 month follow-up
CLARKE2002RCTNo serious limitationsNot applicableAge: 13-18Imprecise/sparse data3242SMD -0.06 (-0.52 to 0.40)AUC 52% (39 to 64)InconclusiveModerate
Self report
CES-D mean depression scores at 12 month follow-up
CLARKE2002RCTNo serious limitationsNot applicableAge: 13-18Imprecise/sparse data3645SMD −0.12 (-0.55 to 0.32)AUC 53% (37 to 71)InconclusiveModerate
CES-D mean depression scores at 24 month follow-up
CLARKE2002RCTNo serious limitationsNot applicableAge: 13-18Imprecise/sparse data3242SMD −0.16 (-0.62 to 0.30)AUC 54% (38 to 67)InconclusiveModerate
Functional status - endpoint
GAF Functional status – mean score
CLARKE1999
CLARKE2002
RCTNo serious limitationsNo important inconsistencyAge: 13-18Imprecise data7574Random Effects SMD − 0.26 (-0.79 to 0.28)AUC 57% (42 to 71)InconclusiveLow
Functional status - follow up
GAF Functional status – mean score at 12 month follow-up
CLARKE2002RCTNo serious limitationsNot applicableAge: 13-18Imprecise data3645SMD 0.19 (-0.25 to 0.63)AUC 42% (26 to 57)Evidence of no differenceModerate
GAF Functional status – mean score at 24 month follow-up
CLARKE2002RCTNo serious limitationsNot applicableAge: 13-18Imprecise data3242SMD 0.21 (-0.25 to 0.67)AUC 44% (32 to 57)Evidence of no differenceModerate
Discontinuation from treatment for any reason by endpoint (Group CBT)
KAHN1990
LEWINSOHN1990
CLARKE1999
CLARKE2002
RCTBlinding not consistently reportedNo important inconsistencyAge: 13-181277% to 18%

RR = relative risk; SMD = standardised mean difference; AUC = The AUC represents the probability that a randomly selected participant in the treatment group has a better result than one in the comparison group. The following values can be used to help judge the magnitude of the effect: 56% = a smaller than typical effect; 64% = typical effect; 71% = larger than typical effect; ≥76% = much larger than typical effect.

*

Clinical threshold for benefit: RR ≤ 0.20 or AUC ≥ 61%; harm: RR ≥ 5 or AUC ≤ 39%.

From: Appendix P, Evidence profile tables

Cover of Depression in Children and Young People
Depression in Children and Young People: Identification and Management in Primary, Community and Secondary Care.
NICE Clinical Guidelines, No. 28.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society; 2005.
Copyright © 2005, The British Psychological Society & The Royal College of Psychiatrists.

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