Effectiveness of CBT on Prolonged Grief Disorder and Depression in Children and Adolescents: A Systematic Review
Keywords:
cognitive behavioral therapy, depression, meta-analysis, prolonged grief disorder, systematic reviewAbstract
This systematic review aimed to evaluate the effectiveness of Cognitive Behavioral Therapy (CBT) in reducing prolonged grief and depression among children and adolescents. A systematic search of randomized controlled trials (RCTs) and quasi-experimental studies was conducted across nine national and international databases (ThaiLIS, ThaiJO, PubMed, Embase, CINAHL, Scopus, ScienceDirect, ProQuest, and Google Scholar) between 2015 and 2025, following the JBI systematic review framework. Out of 619 identified studies, three met the inclusion criteria, consisting of two studies for meta-analysis and one for narrative synthesis. The meta-analysis, using a fixed-effect model, demonstrated that CBT significantly reduced prolonged grief (SMD = -0.75, 95% CI [-1.01, -0.49] ,p < .01) and depression (SMD = -0.57, 95% CI [-0.82 -0.32], p < .01). However, high heterogeneity was observed ( =19.3-27.78, I² = 95-96%), and the certainty of evidence according to GRADE was very low. Narrative synthesis comparing Trauma-Focused CBT (TF-CBT) and Client-Centered Therapy (CCT) showed that both modalities reduced symptoms, but no significant difference in effectiveness was found between groups.
These findings highlight CBT’s potential effectiveness; however, the high heterogeneity and low certainty of evidence underscore the need for high-quality RCTs to enhance evidence homogeneity and confirm clinical effectiveness before widespread implementation.
Downloads
References
Klaochai S, Somjit P, Srivirochai P, Chanthong P, & Wannarit K. Validity and reliability of the Prolonged Grief Disorder-13-Revised Thai version (Thai PG-13-R) among bereaved relatives. Journal of the Psychiatric Association of Thailand. 2023; 68(1): 81-90. (in Thai)
Sarinrat W. Grief from the loss of a loved one. Thai Red Cross Nursing Journal. 2017; 1 :14-20. (in Thai)
Kübler RE. On death and dying. New York: Macmillan; 1969.
Khang M, Lee DH, & Kim Y. Parental Perceptions of Surviving Sibling Grief Responses to an Adolescent’s Violent and Sudden Death by the Sewol Ferry Disaster in South Korea. Journal of Death and Dying. 2020; 81(3): 454-74.
Boelen PA, Lenferink LIM, & Spuij M. CBT for Prolonged Grief in Children and Adolescents: A Randomized Clinical Trial. American Journal of Psychiatry. 2021; 178(4): 294-304.
Bardideh F, Jarareh J, Mofrad M, & Bardideh K. The Effectiveness of Integrated Group Therapy on Prolonged Grief Disorder of Bereaved People from COVID-19 Randomized Controlled Trial. Journal of Death and Dying. 2025; 91(2): 675-92.
Lechner MF, Spuij M, & Boelen PA. Sudden gains in the treatment of children and adolescents with prolonged grief. Journal of consulting and clinical psychology. 2025; 93(1): 14-26.
Hulsey EG, Hill RM, Layne CM, Gaffney DA, & Kaplow JB. Calculating the incidence rate of sibling bereavement among children and adolescents across the United States: A proposed method. Death Studies. 2020; 44(5): 303-11.
Szuhany KL, Malgaroli M, Miron CD, & Simon NM. Prolonged Grief Disorder: Course, Diagnosis, Assessment, and Treatment. Journal of Lifelong Learning in Psychiatry. 2021; 19(2): 161-72.
Carpio DL, Paul S, Paterson A, & Rasmussen S. A systematic review of controlled studies of suicidal and self-harming behaviours in adolescents following bereavement by suicide. Public Library of Science One. 2021; 16(7): 1-29.
Hiyoshi A, Berg L, Grotta A, Almquist Y, & Rostila M. Parental death in childhood and pathways to increased mortality across the life course in Stockholm, Sweden: A cohort study. Public Library of Science Medicine. 2021 ;18(3): 1-16.
Falala A, Lannes A, Bui E, & Revet A. Prevalence of prolonged grief disorder in bereaved children and adolescents: A systematic review. Journal of biological psychiatry and psychopharmacology. 2024; 50(5): 557-65.
Brown EJ, Goodman RF, Cohen JA, Mannarino AP, & Chaplin WF. An Exploratory Trial of Cognitive-Behavioral vs Client-Centered Therapies for Child-Mother Dyads Bereaved from Terrorism. Journal of Child and Adolescent Trauma. 2020; 13(1): 113-25.
Salah S, Hussain S, Ahmed A, Azam A, & Rafique D. Death as Transformation: Examining Grief Under the Perspective of the Kubler-Ross in the Selected Movies. International Journal of English Linguistics. 2018; 9(1): 448-56.
Kittimaskun W, Bunthumporn N, & Vuthiarpa, S. The effect of a cognitive behavioral therapy program on depression among abused adolescents. Journal of The Royal Thai Army Nurses. 2020; 21(1): 329–37. (in Thai)
Treml J, Nagl M, Linde K, Kündiger C, Peterhänsel C, & Kersting A. Efficacy of an Internet-based cognitive-behavioural grief therapy for people bereaved by suicide: a randomized controlled trial. European Journal of Psychotraumatology. 2021; 12(1): 1-12
Aromataris EMZ. JBI Manual for Evidence Synthesis; 2021.
Beck JS. Cognitive behavior therapy: Basics and beyond, 3rd edition. New York, United State: The Guilford Press; 2021.
Dorsey S, Lucid L, Martin P, King KM, Donnell KO, Murray LK, & et al. Effectiveness of task-shifted trauma-focused cognitive behavioral therapy for children who experienced parental death. Journal of the American Medical Association Psychiatry. 2020; 77(5) :464-73.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความหรือข้อคิดเห็นใดใดที่ปรากฏในวารสารพยาบาลทหารบกเป็นวรรณกรรมของผู้เขียน ซึ่งบรรณาธิการหรือสมาคมพยาบาลทหารบก ไม่จำเป็นต้องเห็นด้วย
บทความที่ได้รับการตีพิมพ์เป็นลิขสิทธิ์ของวารสารพยาบาลทหารบก
The ideas and opinions expressed in the Journal of The Royal Thai Army Nurses are those of the authors and not necessarily those
of the editor or Royal Thai Army Nurses Association.
