Effectiveness of Psychological and Educational Interventions to Prevent Depression in Primary Care: A Systematic Review and Meta-Analysis

Abstract

PURPOSE Although evidence exists for the efficacy of psychosocial interventions to prevent the onset of depression, little is known about its prevention in primary care. We aimed to evaluate the effectiveness of psychological and educational interventions to prevent depression in primary care. METHODSWe conducted a systematic review and meta-analysis of relevant randomized controlled trials (RCTs) examining the effect of psychological and educational interventions to prevent depression in nondepressed primary care attendees. We searched MEDLINE, PsycINFO, Web of Science, OpenGrey Repository, Cochrane Central Register of Controlled Trials, and other sources up to May 2016. At least 2 reviewers independently evaluated the eligibility criteria, extracted data, and assessed the risk of bias. We calculated standardized mean differences (SMD) using random-effects models. RESULTSWe selected 14 studies (7,365 patients) that met the inclusion criteria, 13 of which were valid to perform a meta-analysis. Most of the interventions had a cognitive-behavioral orientation, and in only 4 RCTs were the intervention clinicians primary care staff. The pooled SMD was -0.163 (95%CI, -0.256 to -0.070; P = .001). The risk of bias and the heterogeneity (I 2 = 20.6%) were low, and there was no evidence of publication bias. Meta-regression detected no association between SMD and follow-up times or SMD and risk of bias. Subgroup analysis suggested greater effectiveness when the RCTs used care as usual as the comparator compared with those using placebo.CONCLUSIONS Psychological and educational interventions to prevent depression had a modest though statistically significant preventive effect in primary care. Further RCTs using placebo or active comparators are needed. Ann Fam Med 2017;15:262-271. https://doi.org/10.1370/afm.2031. INTRODUCTIONA ccording to the World Health Organization, major depressive disorder affects about 350 million people worldwide. 1 An international study found the average 12-month prevalence of major depression to be 5%. 2 In primary care, though, this figure is higher (11%).3 About 60% to 70% of patients with acute depression experience suicidal ideas, with the actual incidence of suicide in depressive patients being 10% to 15%. 4 Patients with a specific physical illness who develop depression have an excess mortality of 52%. 5 In terms of global disease burden measured in disability-adjusted life years, major depressive disorder increased by 37% between 1990 and 2010 6 and is projected to become the single leading cause of disease burden by 2030 in high-income countries. 7 Two ways exist to reduce the disease burden of depression: treatment and prevention of new cases. Despite effective treatments for depression, the disease burden of depression can be reduced by only 20%; not all cases are recognized, and when recognized, not all patients receive appropriate therapy or adhere to treatment. 263In recent decades interest in prevention has grown, 9 and it is now a key objective in the strategic plan ...

A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial

“…Different studies have shown that depression is preventable [ 5 – 7 ]. In addition, prevention of depression is relatively good value for money [ 8 ].…”

“…In addition, prevention of depression is relatively good value for money [ 8 ]. However, the effect sizes of prevention are small, and most of the interventions are implemented by mental health specialists [ 5 – 7 ]. This jeopardizes its translation to primary health care centres, which may be a good setting for implementing preventive interventions [ 9 ].…”

Effectiveness of psychological and educational interventions for the prevention of depression in the workplace: A systematic review and meta-analysis

“…Information and communication technologies (ICT) can be employed for spreading these preventive interventions, as well as their implementation in settings such as school, primary care and the workplace. Currently, there is evidence of the effectiveness of ICT-based depression prevention programs (11) in schools (12) and primary care (13). Nevertheless, there is a lack of evidence regarding their effectiveness in the workplace.…”

In This Issue: Innovations in Primary Care and at the Annals

“…18 Examining the effectiveness of psychological or educational primary care interventions to prevent depression, a systematic review and meta-analysis of clinical trials finds a small effect. 19 Finally, in contrast, or perhaps in complement to the high-tech interventions in this issue, an essay by Edgoose explores the possibilities for generating hope through a low-tech means: the face-to-face encounter.…”