Comparative efficacy and acceptability of bibliotherapy for depression and anxiety disorders in children and adolescents: a meta-analysis of randomized clinical trials

Figures & data

Figure 1 Flowchart of study selection.

Table 1 Characteristics of included studies

Study	Conditions	Inclusion	Age (range, years)	Interventions (N)	Treatment duration (weeks)	Number of sessions	Parental involvement	Efficacy at posttreatment, SMD (95% CI)	Acceptability at posttreatment, RR (95% CI)
Ackerson et al^Citation41	Depression	CDI ≥10, HAMD ≥10	7–12 grades	BIBLI =15 vs WL =15	4	NA	No	BIBLI vs WL −2.05 (−3.12, −0.97)	BIBLI vs WL 0.60 (0.17, 2.07)
Jacob and De Guzman^Citation43	Depression	BDI-II >14	13–16	BIBLI =15 vs NT =15	6	8	No	BIBLI vs NT −1.68 (−2.53, −0.83)	NA
Rohde et al^Citation45	Depression	CES-D ≥20	13–19	BIBLI =128 vs PBO =124	6	6	No	BIBLI vs PBO −0.20 (−0.45, 0.05)	BIBLI vs PBO 0.73 (0.26, 2.03)
Stice et al^Citation46	Depression	CES-D ≥20	14–19	BIBLI =80 vs PBO =84	6	6	No	BIBLI vs PBO −0.07 (−0.37, 0.24)	BIBLI vs PBO 4.20 (0.48, 36.78)
Cobham^Citation42	Anxiety	ADIS-IV-C/P	7–14	BIBLI =20 vs WL =12	12	12	Yes	BIBLI vs WL −1.21 (−2.00, −0.43)	NA
Lyneham and Rapee^Citation44	Anxiety	ADIS-IV-C/P	7–14	BIBLI =78 vs WL =22	12	12	No	BIBLI vs WL −0.77 (−1.25, 0.28)	BIBLI vs WL 2.54 (0.34, 18.97)
Rapee et al^Citation33	Anxiety	ADIS-IV-C/P	6–12	BIBLI =90 vs WL =87	12	9	Yes	BIBLI vs WL 0.09 (−0.21, 0.38)	BIBLI vs WL 2.34 (1.28, 4.28)
Thirlwall et al^Citation47	Anxiety	ADIS-IV-C/P	7–12	BIBLI =125 vs WL =69	8	8	Yes	BIBLI vs WL 0.12 (−0.88, 0.17)	BIBLI vs WL 2.67 (1.17, 6.11)

Abbreviations: ADIS-IV-C/P, Anxiety Disorders Interview Schedule for DSM-IV, Parent and Child Versions; BDI, Beck Depression Inventory; BIBLI, bibliotherapy; CDI, Children’s Depression Inventory; CES-D, Center for Epidemiologic Study Depression Scale; HAMD, Hamilton Rating Scale for Depression; NA, not applicable; NT, no-treatment control; PBO, psychological placebo; RR, risk ratio; SMD, standardized mean difference; WL, waitlist.

Figure 2 Comparison of bibliotherapy and control conditions for efficacy: change scores in related rating scales.

Abbreviation: CI, confidence interval.

Figure 3 Comparison of bibliotherapy and control conditions for acceptability: all-cause discontinuation from the trials for any reason.

Abbreviation: CI, confidence interval.

Figure 4 Subgroup analyses of efficacy. (A) Forest plot of SMD for change scores in rating scales for type of disorder. (B) Forest plot of SMD for change scores in rating scales for age. (C) Forest plot of SMD for change scores in rating scales for control conditions. (D) Forest plot of SMD for change scores in depression rating scales for parental involvement.

Abbreviations: CI, confidence interval; NT, no-treatment control; PBO, psychological placebo; SMD, standardized mean difference; WL, waitlist.

Figure S1 Percentages for assessments of each risk of bias item across all included studies and individual assessments of each risk of bias item for each included study.

Figure S2 Funnel plot for the efficacy outcome.

Abbreviation: SMD, standardized mean difference.

Figure S3 Sensitivity analysis of primary efficacy outcome, excluding a small-sized study (≤50 patients).

Abbreviation: CI, confidence interval.

Table S1 Key terms for electronic database search

Key terms
1. Title/abstract = (depress* OR dysthymi* OR “mood disorder*” OR “affective disorder*” OR anxiety OR anxious OR phobic OR fear OR fears OR phobia OR phobias OR “panic disorder*” OR “overanxious disorder*” OR “avoidant disorder*” OR agoraphobia OR “selective mutism” OR “panic attack specifier” OR “combat disorder*” OR “mixed disorder*” OR neurosis OR neuroses OR neurotic OR “school refusal”)
2. Title/abstract = (adolesc* OR child* OR boy* OR girl* OR juvenil* OR minors OR paediatri* OR pediatri* OR pubescen* OR school* OR student* OR teen* OR young OR youth*)
3. Title/abstract = (bibliother* OR manual* OR book* OR self-help OR “self help” OR “minimal contact” OR “minimal guidance” OR self-monitoring OR “self-administered treatment*”)
4. 1 AND 2 AND 3

Table S2 Results of the electronic database search

Database	No of citations
PubMed	290
Cochrane	398
EMBASE	144
Web of Science	298
PsycINFO	160
Total	1,290

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