Problem-solving training is a common ingredient of evidence-based therapies for youth depression and has shown effectiveness as a versatile stand-alone intervention in adults. This scoping review provided a first overview of the evidence supporting problem solving as a mechanism for treating depression in youth aged 14 to 24 years. Five bibliographic databases (APA PsycINFO, CINAHL, Embase, MEDLINE, Web of Science) and the grey literature were systematically searched for controlled trials of stand-alone problem-solving therapy; secondary analyses of trial data exploring problem-solving-related concepts as predictors, moderators, or mediators of treatment response within broader therapies; and clinical practice guidelines for youth depression. Following the scoping review, an exploratory meta-analysis examined the overall effectiveness of stand-alone problem-solving therapy. Inclusion criteria were met by four randomized trials of problem-solving therapy (524 participants); four secondary analyses of problem-solving-related concepts as predictors, moderators, or mediators; and 23 practice guidelines. The only clinical trial rated as having a low risk of bias found problem-solving training helped youth solve personal problems but was not significantly more effective than the control at reducing emotional symptoms. An exploratory meta-analysis showed a small and non-significant effect on self-reported depression or emotional symptoms (Hedges’ g = − 0.34; 95% CI: − 0.92 to 0.23) with high heterogeneity. Removing one study at high risk of bias led to a decrease in effect size and heterogeneity (g = − 0.08; 95% CI: − 0.26 to 0.10). A GRADE appraisal suggested a low overall quality of the evidence. Tentative evidence from secondary analyses suggested problem-solving training might enhance outcomes in cognitive-behavioural therapy and family therapy, but dedicated dismantling studies are needed to corroborate these findings. Clinical practice guidelines did not recommend problem-solving training as a stand-alone treatment for youth depression, but five mentioned it as a treatment ingredient. On its own, problem-solving training may be beneficial for helping youth solve personal challenges, but it may not measurably reduce depressive symptoms. Youth experiencing elevated depressive symptoms may require more comprehensive psychotherapeutic support alongside problem-solving training. High-quality studies are needed to examine the effectiveness of problem-solving training as a stand-alone approach and as a treatment ingredient.

中文翻译：

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解决问题训练作为治疗青年抑郁症的有效成分：范围审查和探索性荟萃分析

解决问题的培训是青年抑郁症循证疗法的常见组成部分，并且作为一种针对成人的多功能独立干预措施已显示出有效性。该范围界定审查首次概述了支持问题解决作为治疗 14 至 24 岁青少年抑郁症机制的证据。系统地搜索了五个书目数据库（APA PsycINFO、CINAHL、Embase、MEDLINE、Web of Science）和灰色文献，以进行独立问题解决疗法的对照试验；对试验数据的二次分析，探索与问题解决相关的概念，作为更广泛疗法中治疗反应的预测因子、调节因子或中介因子；和青少年抑郁症的临床实践指南。在范围界定审查之后，一项探索性荟萃分析检查了独立解决问题疗法的整体有效性。四项解决问题疗法的随机试验（524 名参与者）符合纳入标准；对与问题解决相关的概念作为预测因素、调节因素或中介因素进行四项次要分析；和 23 条实践指南。唯一一项被评为低偏倚风险的临床试验发现，解决问题的训练有助于青年解决个人问题，但在减轻情绪症状方面并不比对照组更有效。一项探索性荟萃分析显示对自我报告的抑郁症或情绪症状（Hedges' g = − 0.34；95% CI： − 0.92 至 0.23）具有高异质性的小且不显着的影响。删除一项存在高偏倚风险的研究导致效应量和异质性降低（g = − 0.08；95% CI： − 0。26 到 0.10）。GRADE 评估表明证据的总体质量较低。二次分析的初步证据表明，解决问题的训练可能会提高认知行为治疗和家庭治疗的结果，但需要专门的拆解研究来证实这些发现。临床实践指南不建议将解决问题训练作为青少年抑郁症的独立治疗方法，但有五项指南提到它是一种治疗成分。就其本身而言，解决问题的培训可能有助于帮助青少年解决个人挑战，但可能无法显着减轻抑郁症状。出现抑郁症状升高的青少年可能需要更全面的心理治疗支持以及解决问题的培训。