Comparative Effcacy And Acceptability Of Bibliotherapy For Depression And Anxiety Disorders In Children And Adolescents:A Meta-analysis Of Randomized Clinical Trials

Background: Depression and anxiety are the most common mental disorders in children and adolescents.Bibliotherapy is a treatment of mental health problems using written material.It is ease of use,low cost,low staffing demands and greater privacy.Yet few meta-analyses have focused on the effect of bibliotherapy for depression and anxiety disorders in children and adolescents.Objective: we conducted a conventional meta-analysis to compare the effectiveness and acceptability of bibliotherapy alone for depression and anxiety disorders in children and adolescents.Methods: We included randomized controlled trials comparing bibliotherapy with control conditions for depression and anxiety in children and adolescents(? 18 years old).Five electronic databases(Pub Med,Embase,Cochrane,Web of Science,Psyc INFO)were searched from inception to January,2017.Efficacy was defined as mean change scores in depression and anxiety symptoms.Acceptability was defined as proportion of participants who discontinued treatment.The random effects model was used.An intention-to-treat analysis was conducted.Results: Eight studies with 979 participants were selected.At post-treatment,bibliotherapy was significantly more effective than control in reducing symptoms of depression or anxiety(standardized mean difference [SMD],-0.52;95% confidence interval [CI],-0.89 to-0.15).Bibliotherapy did not have statistically significantly more all-cause discontinuations than controls(risk ratios(RR),1.66;95% CI,0.93 to 2.95).We also performed subgroup analyses for efficacy outcomes in different categories(types of disorder,mean age,control conditions and parental involvement)of studies,and found that bibliotherapy has more effective for depressive adolescents.Limitations: Limited studies were eligible in this review and potential publication bias.Conclusion: According to the findings in this review,bibliotherapy may be more benefic ial in treating depression in adolescents,but shows less robust effects for anxiety in children.Further well-defined clinical studies should be performed to confirm these outcomes.