Prevention of depression with primary care patients: A randomized controlled trial

Muñoz, Ricardo F.; Ying, Yu‐Wen; Bernal, Guillermo; Pérez‐Stable, Eliseo J.; Sorensen, James L.; Hargreaves, William A.; Miranda, Jeanne; Miller, Leonard E.

doi:10.1007/bf02506936

Cited by 211 publications

(150 citation statements)

References 38 publications

(40 reference statements)

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“…The 14 RCTs [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] were published between 1993 and 2016. Six RCTs were conducted in the United States, 3 in Spain, 2 in the Netherlands, 2 in the United Kingdom and 1 in China; 9 were aimed at adults and 5 at specific populations.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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

et al. 2017

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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 ...

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Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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

et al. 2017

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“…The San Francisco Depression Prevention Research Project (DPRP) was a randomized controlled prevention trial conducted with primary care patients ( Muñoz & Ying, 1993 ;Muñoz et al, 1995 ). The study was conducted in English and Spanish, and recruited participants from primary care clinics at San Francisco General Hospital and the University of California, General Medicine Practice.…”

Section: San Francisco Depression Prevention Research Projectmentioning

confidence: 99%

Recruiting and retaining low-income Latinos in psychotherapy research.

Miranda¹,

Azocar²,

Organista³

et al. 1996

Journal of Consulting and Clinical Psychology

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This article offers suggestions for recruiting and retaining low-income Latinos in treatment studies. Because Latinos underuse traditional mental health services, places such as medical centers or churches with large Latino constituents are suggested as useful alternative sources. To keep Latinos in research protocols, providing culturally sensitive treatments are necessary. Culturally sensitive treatments should incorporate families as part of recruitment efforts, particularly older men in the family. In addition, showing respect is an important aspect of traditional Latino culture that includes using formal titles and taking time to listen carefully. Finally, traditional Latinos tend to like interactions with others that are more warm and personal than is generally part of a research atmosphere.Correspondence may be addressed to Jeanne Miranda,

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“…A major goal of the program is to train residents to be responsive to evidence and not propaganda. We teach the most empirically supported psychotherapies as potential first-line therapies as well as medication management for depression.Before this program, few residents were able to offer the most disease-specific, empirically proven psychotherapies for depression, cognitive therapy (CT) [2] and interpersonal psychotherapy (IPT) [3]. Instead, residents treated nearly all patients with long-term psychotherapy (with or without medications), despite the lack of strong evidence for the effectiveness of this modality in major depression.…”

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confidence: 99%

“…(2) patient education information available in written form and on our website: http://www.ucsf.edu/psych/cwd.htm; (3) 12-week CT [1]; (4) 16-week IPT [2]; (5) booster sessions of CT or IPT for relapse prevention; (6) medication management based on guidelines developed from a review of the literature; and (7) initial and regular follow-up Beck Depression Inventory IIs [4] to monitor clinical symptom course and inform treatment decisions.…”

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confidence: 99%