Korean Clinical Psychology Association

Korean Journal of Clinical Psychology - Vol. 37 , No. 4

[ Review Article ]
Korean Journal of Clinical Psychology - Vol. 37 , No. 4 , pp.595-604
ISSN: 2733-4538 (Online)
publication date 30 Nov 2018
Received 18 Sep 2018 Revised 16 Nov 2018 Accepted 18 Nov 2018
DOI: https://doi.org/10.15842/kjcp.2018.37.4.011

아동·청소년 우울증의 근거기반치료
한양사이버대학교 상담심리학과

Evidence-Based Treatments for Depression in Children and Adolescents
Kyoung Min Shin
Department of Counseling Psychology, Hanyang Cyber University, Seoul, Korea
Correspondence to : Kyoung Min Shin, Department of Counseling Psychology, Hanyang Cyber University, 220 Wangsimni-ro, Seongdong-gu, Seoul, Korea; E-mail: kmshin@hycu.ac.kr

© 2018 Korean Clinical Psychology Association


우울한 기분과 흥미나 즐거움의 감소가 주요 증상인 우울장애는 대중적으로 널리 알려진 정신장애 중 하나이다. 아동·청소년기의 우울증의 높은 만성화 가능성과 한 개인의 삶에 미치는 장기적인 영향에 대한 인식이 높아지면서 아동·청소년 우울증에 대한 심리치료에 대한 관심 또한 더욱 높아지고 있다. 이에 본 논문에서는 아동·청소년 우울장애에 관한 최근 20년간 해외 및 국내 연구 결과에 근거하여 심리치료의 효과를 살펴보고, 관련 연구 결과들을 정리 및 요약하여, 이를 바탕으로 아동·청소년 우울장애에 대한 근거기반심리치료의 권고안을 제시하였다. 해외의 메타분석 연구와 체계적인 리뷰를 근거로 인지행동치료(CBT)와 대인관계치료(IPT)를 “치료효과가 강력하고 근거가 잘 정립된 치료법(strong/well-established)”으로, 가족치료(FT)를 “효과가 있음직한 치료법(modest/probably efficacious)”으로, 마지막으로 정신역동치료(PDT)는 “실험적인 수준의 치료법(controversial/experimental)”으로 제안하였다. 국내에서 실시된 연구를 개관한 결과, 사전-사후 설계연구가 주를 이루고 있었으며 이를 통해 국내에서는 CBT와 IPT를 “효과가 있음직한 치료법(modest/probably efficacious)”으로 제안하였다. 마지막으로 국내 심리치료 연구의 현황과 문제점 및 연구 방향에 대해 논의하였다.


Depression in child and adolescent tends to presage a chronic and recurrent course of illness and impairment in adulthood. Concerns about medication also prompt growing interest in the effects of psychotherapy in child and adolescent depression. The main purpose of this study is to identify evidence-based treatments of child and adolescent depression. For this purpose, we reviewed the clinical features and researches on evidence-based treatments of child and adolescent depression. Based on overseas meta-analysis and systematic reviews, both cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) have a “strong/well-established” evidence base, family therapy (FT) has a “modest/probably efficacious” evidence, and psychodynamic therapy (PDT) has a “controversial/experimental” base. Although domestic researches on psychotherapy are limited, several trials had examined the efficacy of CBT or IPT for youth depression. Based on domestic researches, CBT and IPT have a “modest/probably efficacious” evidence base in Korea.

Keywords: depression, children, adolescents, evidence-based treatment, psychotherapy effectiveness
키워드: 우울증, 아동, 청소년, 근거기반치료, 심리치료 효과성

1. Abbass, A., Rabung, S., Leichsenring, F., Refseth, J., & Midgley, N. (2013). Psychodynamic psychotherapy for children and adolescents: a meta-analysis of short-term psychodynamic models. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 863-875.
2. Ahn, J., Kim, M., & Sung, J. (2012). The effects of group cognitive-behavioral therapy on depression and anxiety in adolescents. Duksung Journal Social Sciences, 18, 1-18.
3. Andrews, G., Sanderson, K., Corry, E., & Lapsley, H. M. (2000). Using epidemiological data to model efficiency in reducing the burden of depression. The Journal of Mental Health Policy and Economics, 175-186.
4. Angold, A., & Costello, E. J. (1993). Depressive comorbidity in children and adolescents: empirical, theoretical, and methodological issues. The American Journal of Psychiatry, 1779-1791.
5. Arnberg, A., & Öst, L. G. (2014). CBT for Children with Depression Symptoms: A Meta-Analysis. Cognitive Behaviour Therapy, 275-288.
6. Birmaher, B., Ryan, N. D., Williamson, D. E., Brent, D. A., Kaufman, J., Dahl, R. E., . . . & Nelson, B. (1996). Childhood and adolescent depression: A review of the past 10 years. Part I. Journal of the American Academy of Child and Adolescent Psychiatry, 1427-1439.
7. Bolton, P., Bass, J., Betancourt, T., Speelman, L., Onyango, G., Clougherty, K. F., . . . & Verdeli, H. (2007). Intervention for depression symptoms among adolescent survivors of war and displacement in northern Uganda: a randomized controlled trial. JAMA: Journal of the American Medical Association, 519-527.
8. Brent, D., Kolko, D., Birmaher, B., & Baugher, M. (1998). Predictors of treatment efficacy in a clinical trial of three psychosocial treatments for adolescent depression. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 906-914.
9. Cheung, A. H., Zuckerbrot, R. A., Jensen, P. S., Ghalib, K., Laraque, D., & Stein, R. E. (2007). Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and ongoing management. Pediatrics, e1313-1326.
10. Choi, J., & Kim, J. (2008). The effect of Gestalt group art therapy in children of low income, broken families with internalization problems. The Korea Journal of Counseling, 1167-1181.
11. Cotrell, D. (2003). Outcome studies of family therapy in child and adolescent depression. Journal of Family Therapy, 406-416.
12. Dietz, L. J., Mufson, L., Irvine, H., & Brent, D. A. (2008). Family-based interpersonal psychotherapy for depressed preadolescents: And open-treatment trial. Early Intervention in Psychiatry, 154-161.
13. Dietz, L. J., Weinberg, R. J., Brent, D. A., & Mufson, L. (2015). Family-based interpersonal psychotherapy for depressed preadolescents: Examining efficacy and potential treatment mechanisms. Journal of the American Academy of Child and Adolescent Psychiatry, 191-199.
14. Flament, M. F., Cohen, D., Choquet, M., Jeammet, P., & Ledoux, S. (2011). Phenomenology, psychosocial correlates and treatment seeking in major depression and dysthymia in adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 1070-1078.
15. Gálvez-Lara, M., Corpas, J., Moreno, E., Venceslá, J., Sánchez-Raya, A., & Moriana, J. A. (2018). Psychological treatments for mental disorders in children and adolescents: A review of the evidence of leading international organizations. Clinical Child and Family Psychology Review, 366-387.
16. Ha, E. H., Oh, K. J., Song D. H., & Kang, J. H. (2004). The effects of cognitive-behavioral group therapy for depression and anxiety disorders in adolescents: A preliminary study. The Korean Journal of Clinical Psychology, 263-279.
17. Hammen, C., Brennan, P. A. & Keenan-Miller, D. (2008). Patterns of adolescent depression to age 20: The role of maternal depression and youth interpersonal dysfunction. Journal of Abnormal Child Psychology, 1189-1198.
18. Harrington, R., & Dubicka, B. (2002). Adolescent depression: and evidence-based approach to intervention. Current Opinion in Psychiatry, 369-375.
19. Harrington, R., Whittaker, J., & Shoebridge, P. (1998). Psychological treatment of depression in children and adolescents. A review of treatment research. British Journal of Psychiatry, 291-298.
20. Harrington, R. C. (1996). Family-genetic findings in child and adolescent depressive disorders. International Review of Psychiatry, 355-368.
21. Hetrick, S. E., McKenzie, J. E., Cox, G. R., Simmons, M. B., & Merry, S. N. (2012). Newer generation antidepressants for depressive disorders in children and adolescents. The Cochrane database of systematic reviews, CD004851.
22. Hickie, B., Fogarty, A. S., Davenport, T. A., Luscombe, G. M., & Burns, J. (2007). Responding to experiences of young people with common mental health problems attending Australian general practice. The Medical Journal of Australia, S47-52.
23. Hong, K. (2014). Korean textbook of child psychiatry. Seoul: Hakjisa.
24. Hyun, M. S., & Kim, M. A. (2004). The effects of the cognitive-behavioral therapy on depression and self efficacy of the problem behavior adolescents in middle school. Journal of Korean Psychiatric and Mental Health Nursing Academic Society, 458-466.
25. Jin, S., & Son, C. (2015). Effects of interpersonal psychotherapy for group (IPT-G) on depression decrease, anger control, and suicidal ideation decrease of depression-prone adolescents. Korean Journal of Clinical Psychology, 649-666.
26. Kang, Y., & Ahn, C. (2004). The effectiveness of group play therapy program for depressive children. The Korean Journal of Clinical Psychology, 541-558.
27. Kim, B., & Cho, S. (2000). Treatment strategies for the child & adolescent patients with depressive disorder. Korean Journal of Psychopharmacology, 216-231.
28. Kim, S. H., & Kim, C. K. (2009). Efficacy of interpersonal psychotherapy for group (IPT-G) to decrease depression and improve the self esteem of adolescents. Journal of Emotional and Behavioral Disorders, 183-204.
29. Kim, S. H., & Kim, C. K. (2010). The effects of interpersonal psychotherapy for group and cognitive-behavioral therapy for group on depression and related variables in adolescents. Korean Journal of Youth Studies, 55-86.
30. Kim, T. H., & Shin, H. (2011). The effects of a cognitive-behavioral program on depressive vulnerability reduction in the children of low-income families: Focus on dysfunctional attitudes and low self-esteem. The Korean Journal of Clinical Psychology, 907-927.
31. Klein, J. B., Jacobs, R. H., & Reinecke, M. A. (2007). Cognitive-behavioral therapy for adolescent depression: A meta-analytic investigation of changes in effect-size estimates. Journal of the American Academy of Child and Adolescents Psychiatry, 1403-1414.
32. Klerman, G. L., & Weissman, M. M. (1986). The interpersonal approach to understanding depression. New York: Guilford Press.
33. Koo, H. J., Choi, S. M., & Kwon, J. H. (2012). Youth psychotherapy outcome research: methodological review and meta-analysis. The Korean Journal of Clinical Psychology, 43-73.
34. Korean academy of child and adolescent psychiatry. (2012). Adolescent psychiatry. Seoul: Sigmapress.
35. Kovacs, M., Feinberg, T. L., Crouse-Novak, M. A., Paulauskas, S. L., & Finkelstein, R. (1984). Depressive disorders in childhood. I. A longitudinal prospective study of characteristics and recovery. Archives of General Psychiatry, 229-237.
36. Ko, Y. J., & Kim, J. M. (2011). The effects of cognitive behavioral therapy using books on depression and social skills of adolescents from single-parent low-income families. The Journal of Play Therapy, 35-51.
37. Kwon, T. (2015). A meta-analysis of the effects of depressive symptoms prevention programs for children and adolescents. Korean Journal of Social Welfare Studies, 35-64.
38. Lewinsohn, P. M., Clarke, G. N., Seeley, J. R., & Rohde, P. (1994). Major depression in community adolescents: Age at onset, episode duration, and time to recurrence. Journal of the American Academy of Child & Adolescents Psychiatry, 809-818.
39. Lewinsohn, P. M., Rohde, P., & Seeley, J. R. (1998). Major depressive disorder in older adolescents: Prevalence, risk factors, and clinical implications. Clinical Psychology Review, 765-794.
40. Meltzer, H., Gatward, R., Goodman, R., & Ford, T. (2000). The Mental Health of Children and Adolescents in Great Britain, The report of a survey carried out in 1999 by Social Survey Division of the Office for National Statistics on behalf of the Department of Health, the Scottish Health Executive and the National Assembly for Wales. London: The Stationery Office.
41. Merikangas, K. R., Zhang, H., Avenevoli, S., Acharyya, S., Neuenschwander, M., & Angst, J. (2003). Longitudinal trajectories of depression and anxiety in a prospective community study. Archives of General Psychiatry, 993-1000.
42. Midgley, N., & Kennedy, E. (2011). Psychodynamic psychotherapy for children and adolescents: a critical review of the evidence base. Journal of Child Psychotherapy, 232-260.
43. Mufson, L., Moreau, D., Weissman, M. M., & Klerman, G. L. (1993). Interpersonal psychotherapy for depressed adolescents. New York: The Guilford Press.
44. Mufson, L., Weissman, M. M., Moreau, D., & Garfinkel, R. (1999). Efficacy of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry, 573-579.
45. Pu, J., Zhou, X., Lanxiang, L., Zhang, Y., Yang, L., Yuan, S., . . . & Xie, P. (2017). Efficacy and acceptability of interpersonal psychotherapy for depression in adolescents: A meta-analysis of randomized controlled trials. Psychiatry Research, 226-232.
46. Qin, B., Zhang, Y., Zhou, X., Cheng, P., Liu, Y., Chen, J., . . . & Xie, P. (2014). Selective serotonin reuptake inhibitors versus tricyclic antidepressants in young patients: A meta-analysis of efficacy and acceptability. Clinical Therapeutics, 1087-1095.
47. Rossello, J., & Bernal, G. (1999). The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Rican adolescents. Journal of Consulting and Clinical Psychology, 734-745.
48. Tang, T. C., Jou, S. H., Ko, C. H., Huang, S. Y., & Yen, C. F. (2009). Randomized study of school-based intensive interpersonal psychotherapy for depressed adolescents with suicidal risk and parasuicide behaviors. Psychiatry and Clinical Neurosciences, 463-470.
49. Trowell, J., Joffe, I., Campbell, J., Clemente, C., Almgvist, F., Soininen, M., . . . & Tsiantis, J. (2007). Childhood depression: A place for psychotherapy - And outcome study comparing individual psychodynamic psychotherapy and family therapy. European Child and Adolescent Psychiatry, 157-167.
50. Wagner, K. D., & Brent, D. A. (2009). Depressive Disorder and Suicide. In Sadock, B. J., Sadock, V. A., & Ruiz, S.V. Comprehensive Textbook of psychiatry (Vol. 2, pp. 3652-3658). Philadelphia: Lippincott Williams & Wilkins.
51. Weersing, V. R., Jeffreys, M., Do, M. T., Schwartz, K. T. G., & Bolano, C. (2017). Evidence base update of psychosocial treatments for child and adolescent depression. Journal of Clinical Child & Adolescent Psychology, 11-43.
52. Weissman, M. M., Wolk, S., Goldstein, R. B., Moreau, D., Adams, P., Greenwald, S., . . . & Wickramaratne, P. (1999). Depressed adolescents grown up. JAMA: Journal of the American Medical Association, 1707-1713.
53. Whittington, C. J., Kendall, T., Fonagy, P., Cottrell, D., Cotgrove, A., & Boddington, E. (2004). Selective serotonin reuptake inhibitors in childhood depression: Systematic review of published versus unpublished data. Lancet, 1341-1345.
54. Yang, S., Yim, W., & Choi, M. (2005). The effect of child centered play therapy on the depression and hostility decrease of a child who is institutionalized. Korean Journal of Child Welfare, 35-47.
55. Zhou, X., Hetrick, S. E., Cuijpers, O., Qin, B., Barth, J., Whittington, C. J., . . . & Xie, P. (2015). Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis. World psychiatry, 207-222.
56. Zisook, S., Lesser, I., Stewart, J. W., Wisniewski, S. R., Balasubramani, G. K., Fava, M., . . . & Rush, A. J. (2007). Effect of age at onset on the course of major depressive disorder. The American Journal of Psychiatry, 1539-1546.