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      Cribado de la depresión mayor en la infancia y adolescencia (parte 2) Translated title: Screening for depression in chilhood and adolescence (part 2)

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          Abstract

          Resumen El síndrome depresivo que aparece durante la infancia o la adolescencia tiende a seguir un curso crónico, con alta probabilidad de permanecer en la edad adulta. Su sintomatología repercute en la vida diaria del menor y, en el caso de la depresión mayor, supone un riesgo para la aparición de conducta suicida. Dada la variabilidad de sus manifestaciones clínicas y las dificultades en el diagnóstico, se plantea la posible utilidad del uso de cuestionarios de cribado en la población infantil y adolescente, a partir de un análisis del rendimiento de estos y de la eficacia de las medidas terapéuticas actuales. El presente trabajo se ha dividido en dos partes, y al final de este se recopilan las recomendaciones de distintos grupos de trabajo y tras el análisis de la evidencia, las recomendaciones que el grupo PrevInfad ha consensuado para la consulta de los pediatras en Atención Primaria.

          Translated abstract

          Abstract The depressive syndrome that appears during childhood or adolescence tends to follow a chronic course, with a high probability of remaining in adulthood. Its symptoms affect the daily life of the minor and in case of major depression, it poses a risk for the onset of suicidal behavior. Given the variability of its clinical manifestations and the difficulties in diagnosis, the possible usefulness of the use of screening questionnaires in the child and adolescent population is proposed, based on an analysis of their performance and the efficacy of current therapeutic measures. This article, which has been divided in two parts, ends with several recommendations for the consultation of pediatricians in Primary Care made by PrevInfad Group, after analyzing their evidence.

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          Most cited references28

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          Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis

          Major depressive disorder is one of the most common mental disorders in children and adolescents. However, whether to use pharmacological interventions in this population and which drug should be preferred are still matters of controversy. Consequently, we aimed to compare and rank antidepressants and placebo for major depressive disorder in young people.
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            Practice parameter for the assessment and treatment of children and adolescents with depressive disorders.

            This practice parameter describes the epidemiology, clinical picture, differential diagnosis, course, risk factors, and pharmacological and psychotherapy treatments of children and adolescents with major depressive or dysthymic disorders. Side effects of the antidepressants, particularly the risk of suicidal ideation and behaviors are discussed. Recommendations regarding the assessment and the acute, continuation, and maintenance treatment of these disorders are based on the existent scientific evidence as well as the current clinical practice.
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              Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis.

              Previous meta-analyses of psychotherapies for child and adolescent depression were limited because of the small number of trials with direct comparisons between two treatments. A network meta-analysis, a novel approach that integrates direct and indirect evidence from randomized controlled studies, was undertaken to investigate the comparative efficacy and acceptability of psychotherapies for depression in children and adolescents. Systematic searches resulted in 52 studies (total N=3805) of nine psychotherapies and four control conditions. We assessed the efficacy at post-treatment and at follow-up, as well as the acceptability (all-cause discontinuation) of psychotherapies and control conditions. At post-treatment, only interpersonal therapy (IPT) and cognitive-behavioral therapy (CBT) were significantly more effective than most control conditions (standardized mean differences, SMDs ranged from -0.47 to -0.96). Also, IPT and CBT were more beneficial than play therapy. Only psychodynamic therapy and play therapy were not significantly superior to waitlist. At follow-up, IPT and CBT were significantly more effective than most control conditions (SMDs ranged from -0.26 to -1.05), although only IPT retained this superiority at both short-term and long-term follow-up. In addition, IPT and CBT were more beneficial than problem-solving therapy. Waitlist was significantly inferior to other control conditions. With regard to acceptability, IPT and problem-solving therapy had significantly fewer all-cause discontinuations than cognitive therapy and CBT (ORs ranged from 0.06 to 0.33). These data suggest that IPT and CBT should be considered as the best available psychotherapies for depression in children and adolescents. However, several alternative psychotherapies are understudied in this age group. Waitlist may inflate the effect of psychotherapies, so that psychological placebo or treatment-as-usual may be preferable as a control condition in psychotherapy trials.
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                Author and article information

                Journal
                pap
                Pediatría Atención Primaria
                Rev Pediatr Aten Primaria
                Asociación Española de Pediatría de Atención Primaria (Madrid, Madrid, Spain )
                1139-7632
                September 2020
                : 22
                : 87
                : 311-321
                Affiliations
                [4] Valencia orgnameCentro de Salud Paterna España
                [2] Madrid orgnameHospital Universitario 12 de Octubre orgdiv1Servicio de Neonatología España
                [8] Madrid orgnamePediatra de Atención Primaria España
                [5] Granada orgnameCentro de Salud Zaidín Sur España
                [3] Velilla de San Antonio. Madrid orgnamePediatra. Centro de Salud Mejorada del Campo España
                [7] Madrid orgnameCentro de Salud Canillejas España
                [1] Málaga orgnameCentro de Salud Trinidad España
                [6] Valencia orgnameUniversidad de Valencia orgdiv1Unidad de Pediatría orgdiv2Departamento de Pediatría, Obstetricia y Ginecología España
                [10] Zaragoza orgnameCentro de Salud Delicias Sur España
                [9] Zaragoza orgnameCentro de Salud Torrero La Paz España
                Article
                S1139-76322020000400017 S1139-7632(20)02208700017
                2403e61b-9b73-44c7-9a53-d3cc4c36aa19

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 28, Pages: 11
                Product

                SciELO Spain

                Categories
                Grupo PrevInfad/PAPPS Infancia y Adolescencia

                Depression,Depresión,Cribado,Screening
                Depression, Depresión, Cribado, Screening

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