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BMC Psychiatry
Published in: BMC Psychiatry 1/2024

Open Access 01-12-2024 | Systemic Therapy | Research

Systemic therapy in children and adolescents with mental disorders: a systematic review and meta-analysis

Authors: David Henry Seidel, Martina Markes, Ulrich Grouven, Claudia-Martina Messow, Wiebke Sieben, Marco Knelangen, Rieke Oelkers-Ax, Sebastian Grümer, Heike Kölsch, Mandy Kromp, Markus von Pluto Prondzinski

Published in: BMC Psychiatry | Issue 1/2024

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Abstract

Background

Systemic therapy (ST) is a psychotherapeutic intervention in complex human systems (both psychological and interpersonal). Cognitive behavioural therapy (CBT) is an established treatment for children and adolescents with mental disorders. As methodologically rigorous systematic reviews on ST in this population are lacking, we conducted a systematic review and meta-analysis to compare the benefit and harm of ST (and ST as an add-on to CBT) with CBT in children and adolescents with mental disorders.

Methods

We searched MEDLINE, Embase, PsycINFO and other sources for randomised controlled trials in 14 mental disorder classes for the above comparisons in respect of effects on patient-relevant outcomes (search date: 7/2022). Where possible, meta-analyses were performed and results were graded into 3 different evidence categories: “proof”, “indication”, or “hint” (or none of these categories). PRISMA standards were followed.

Results

Fifteen studies in 5 mental disorder classes with usable data were identified. 2079 patients (mean age: 10 to 19 years) were analysed. 12/15 studies and 29/30 outcomes showed a high risk of bias. In 2 classes, statistically significant and clinically relevant effects in favour of ST were found, supporting the conclusion of a hint of greater benefit of ST for mental and behavioural disorders due to psychoactive substance use and of ST as an add-on to CBT for obsessive-compulsive disorders. In 2 other classes (eating disorders; hyperkinetic disorders), there was no evidence of greater benefit or harm of ST. For affective disorders, a statistically significant effect to the disadvantage of ST was found for 1 outcome, supporting the conclusion of a hint of lesser benefit of ST.

Conclusions

Our results show a hint of greater benefit of ST (or ST as an add-on to CBT) compared with CBT for 2 mental disorder classes in children and adolescents (mental and behavioural disorders due to psychoactive substance use, obsessive compulsive disorders). Given the importance of CBT as a control intervention, ST can therefore be considered a beneficial treatment option for children and adolescents with certain mental disorders. Limitations include an overall high risk of bias of studies and outcomes and a lack of data for several disorders.
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Metadata
Title
Systemic therapy in children and adolescents with mental disorders: a systematic review and meta-analysis
Authors
David Henry Seidel
Martina Markes
Ulrich Grouven
Claudia-Martina Messow
Wiebke Sieben
Marco Knelangen
Rieke Oelkers-Ax
Sebastian Grümer
Heike Kölsch
Mandy Kromp
Markus von Pluto Prondzinski
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2024
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-024-05556-y

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