Abstract
BACKGROUND: Research has shown that non-pharmacological interventions (NPIs) can effectively reduce anxiety and depression in children and adolescents; however, there remains a lack of agreement on this topic. This review aims to assess the effectiveness of NPIs in alleviating depression and anxiety in children and adolescents when compared to control groups. METHODS: A comprehensive search of electronic databases, including PubMed, PsycINFO, OVID, ProQuest, EBSCO host, and Cochrane, was conducted for studies published from 2009 to May 2023. Studies that employed NPIs to evaluate their impact on anxiety and depression in children and adolescents were included. RESULTS: Out of 3680 study records screened, 15 studies (32 arms, 6851 participants) met the inclusion criteria for the final analysis. The pooled analysis indicated a statistically significant difference between NPIs and control groups regarding depression (standardized mean difference [SMD] -0.15, 95% CI -0.27, -0.03; p = 0.01, I2 = 74%) and anxiety (SMD -0.48, 95% CI -0.76, -0.20; p = 0.0007, I2 = 77%). Subgroup analyses showed a significant difference in depression outcomes for adolescents, while NPIs notably improved anxiety in children. However, NPIs did not yield significant improvements in depression among children. CONCLUSIONS: This review underscores the positive impact of NPIs on reducing anxiety and depression in adolescents and children. Future research on NPI interventions should focus on long-term effects and well-structured methodologies to establish definitive conclusions regarding depression in children. Clinicians and practitioners should interpret these findings with caution, considering the methodological limitations present in the studies. STUDY REGISTRATION: The proposal has been registered with The International Prospective Register of Systematic Reviews (PROSPERO 2023) CRD42023390189.