Network meta-analysis of non-pharmacological interventions for subthreshold depression in youth

Photo by GuerrillaBuzz / Unsplash

Frontiers in Medicine Published May 13, 2026 Medically reviewed May 13, 2026 Study authors: Qipei Ji, Zhenbo Wang, Xiaobo Wang, Ling Zhou, Zhenkui Lou, Meiling Su, Xin Gao, Shufang Jiang, Hong… DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider behavioral activation as a first-line option for subthreshold depression in youth, based on moderate-certainty evidence.

This is a systematic review and network meta-analysis of non-pharmacological interventions for subthreshold depression in adolescents and young adults aged 11 to 25 years who did not meet diagnostic criteria for major depression. The review included 3,471 participants and compared interventions to waitlist control or usual care.

The authors synthesized evidence that non-pharmacological interventions significantly improved depressive symptoms, with a pooled standardized mean difference of SMD = -0.93 (95% CI: -1.20 to -0.66, P < 0.05). The certainty of evidence was graded using the CINeMA tool.

Key limitations noted by the authors include high heterogeneity across studies, single-study evidence for some interventions (e.g., LT, PEI), a broad age range of participants, and a lack of long-term follow-up data. Adverse events were not reported.

The authors recommend behavioral activation as a first-line clinical option and suggest that clinical selection of interventions should consider individual patient characteristics and intervention features. Practice relevance is restrained due to the noted limitations and evidence gaps.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

Subthreshold depression (SD) is highly prevalent in adolescents and young adults aged 11–25 years, leading to impaired psychosocial functioning and a high risk of progression to major depressive disorder (MDD). Non-pharmacological therapies are the mainstay of intervention for adolescent SD, yet the comparative efficacy of different interventions remains unclear. This study aimed to compare the relative effectiveness of various non-pharmacological interventions for adolescent SD via network meta-analysis (NMA). We initially retrieved 5,297 records from six databases (PubMed, Embase, Web of Science, Cochrane, PsycINFO, CINAHL) for randomized controlled trials (RCTs) of non-pharmacological interventions for SD in individuals aged 11–25 years who did not meet the DSM-IV/ICD-10 diagnostic criteria for MDD or depressive episode. The control groups received waitlist control or usual care, and the primary outcome was depressive symptoms assessed by validated scales (BDI-II, CES-D, CDI, HAMD). Two reviewers independently conducted study selection, data extraction and risk of bias assessment (RoB 2.0). Heterogeneity was analyzed using the I² statistic; NMA was performed under a Bayesian framework with consistency assessment, and the CINeMA tool was used to grade the certainty of evidence. This study was registered in PROSPERO (CRD42023456264) and reported in accordance with the PRISMA 2020 statement. A total of 30 RCTs involving 3,471 participants were included. Traditional meta-analysis showed that non-pharmacological interventions significantly improved depressive symptoms in adolescents with SD (pooled SMD = −0.93, 95% CI: −1.20 to −0.66, P Non-pharmacological interventions are effective for adolescents with SD, and BA is recommended as the first-line clinical option. Clinical selection of interventions should take into account individual patient characteristics and intervention features. This study has several limitations, including high heterogeneity across studies, single-study evidence for some interventions (e.g., LT, PEI), a broad age range of participants and the lack of long-term follow-up data. Further large-scale, multi-center RCTs are needed to validate these findings.