Primary prevention of depression: An umbrella review of controlled interventions.

Abstract

BACKGROUND:

Primary prevention has the potential to modify the course of depression, but the consistency and magnitude of this effect are currently undetermined.

METHODS:

PRISMA and RIGHT compliant (PROSPERO:CRD42020179659) systematic meta-review, PubMed/Web of Science, up to June 2020. Meta-analyses of controlled interventions for the primary prevention of depressive symptoms [effect measures: standardized mean difference (SMD)] or depressive disorders [effect measure: relative risk (RR)] were carried out. Results were stratified by: (i) age range; (ii) target population (general and/or at-risk); (iii) intervention type. Quality (assessed with AMSTAR/AMSTAR-PLUS content) and credibility (graded as high/moderate/low) were assessed. USPSTF grading system was used for recommendations.

RESULTS:

Forty-six meta-analyses (k=928 individual studies, n=286,429 individuals, mean age=22.4 years, 81.1% female) were included. Effect sizes were: SMD=0.08-0.53; for depressive symptoms; RR=0.90-0.28 for depressive disorders. Sensitivity analyses including only RCTs did not impact the findings. AMSTAR median=9 (IQR=8-9); AMSTAR-PLUS content median=4.25 (IQR=4-5). Credibility of the evidence was insufficient/low in 43 (93.5%) meta-analyses, moderate in two (4.3%), and high in one (2.2%): reduction of depressive symptoms using psychosocial interventions for young adults only, and a combination of psychological and educational interventions in primary care had moderate credibility; preventive administration of selective serotonin reuptake inhibitors (SSRIs) for depressive disorders in individuals with a stroke had high credibility.

LIMITATIONS:

Intervention heterogeneity and lack of long-term efficacy evaluation.

CONCLUSIONS:

Primary preventive interventions for depression might be effective. Among them, clinicians may offer SSRIs post-stroke to prevent depressive disorders, and psychosocial interventions for children/adolescents/young adults with risk factors or during the prenatal/perinatal period.

• Authors: Gonzalo Salazar de Pablo, Marco Solmi, Julio Vaquerizo-Serrano, Joaquim Radua, Anastassia Passina, Pierluca Mosillo, Christoph U Correll, Stefan Borgwardt, Silvana Galderisi, Andreas Bechdolf, Andrea Pfennig, Michael Bauer, Lars Vedel Kessing, Therese van Amelsvoort, Dorien H Nieman, Katharina Domschke, Marie-Odile Krebs, Michael Sand, Eduard Vieta, Philip McGuire, Celso Arango, Jae Il Shin, Paolo Fusar-Poli
• Journal: Journal of affective disorders (J Affect Disord) Vol. 294 Pg. 957-970 (11 01 2021) ISSN: 1573-2517 [Electronic] Netherlands
• PMID: 34375224 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review, Systematic Review)
• Copyright: Copyright © 2021. Published by Elsevier B.V.

Chemical References

• Serotonin Uptake Inhibitors

Topics

• Adolescent
• Adult
• Child
• Depression
• Female
• Humans
• Male
• Primary Health Care
• Primary Prevention
• Selective Serotonin Reuptake Inhibitors
• Young Adult