Adjunctive psychosocial interventions for children and adolescents with bipolar spectrum disorders: a systematic review and meta-analysis.

Abstract

Identifying effective treatments is essential for improving long-term outcomes in children and adolescents (C&A) with bipolar spectrum disorder (BSD), for whom evidence-based psychosocial interventions remain limited. This PRISMA-compliant meta-analysis (PROSPERO: CRD42024552462) synthesized the evidence on psychosocial interventions for C&A with BSD. Databases were searched until July 1, 2025, including studies with or without control groups. Data extraction was conducted independently. RoB 2 was used for RCTs and ROBINS-I for non-randomized studies. Twenty-eight studies from 16 independent samples were included (mean age = 15.02 ± 1.76 years; 59.13% females), encompassing interventions focused on psychoeducation, cognitive-behavioral strategies, skills training, and family involvement. Evidence varied across intervention types, developmental stages, treatment durations, and study designs. In pre-post analyses, significant reductions were observed in depressive (Hedges' g = 0.586, 95% CI = 0.282-0.889) and manic symptoms (Hedges' g = 0.485, 95% CI = 0.293-0.678). In mixed-design controlled analyses, CBT-based multicomponent intervention showed preliminary evidence of greater reductions in depressive (Hedges' g = 0.390, 95% CI = 0.114-0.666; K = 3, N = 117) and manic symptoms (Hedges' g = 0.718, 95% CI = 0.303-1.133; K = 3, N = 117) compared with control conditions. Among RCT publications, 1 (5.9%) was judged to be at low risk of bias and 16 (94.1%) as having some concerns; all 11 non-randomized studies were judged to be at serious risk of bias. Overall, adjunctive psychosocial interventions may improve mood symptoms, but controlled estimates from three studies, including one small non-randomized study, are preliminary, potentially unstable, and sensitive to its inclusion. The limited number of high-quality randomized trials highlights the need for rigorous research to clarify intervention components and inform clinical care.