Primary prevention of depression: An umbrella review of controlled interventions

•This systematic meta-review provides a comprehensive, evidence-based appraisal of the efficacy of preventive interventions for depression.•87.2% of the interventions were significantly superior to the control condition for depressive symptoms; 75% of the interventions were significantly superior to...

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Published in:	Journal of affective disorders Vol. 294; pp. 957 - 970
Main Authors:	Salazar de Pablo, Gonzalo, Solmi, Marco, Vaquerizo-Serrano, Julio, Radua, Joaquim, Passina, Anastassia, Mosillo, Pierluca, Correll, Christoph U, Borgwardt, Stefan, Galderisi, Silvana, Bechdolf, Andreas, Pfennig, Andrea, Bauer, Michael, Kessing, Lars Vedel, van Amelsvoort, Therese, Nieman, Dorien H., Domschke, Katharina, Krebs, Marie-Odile, Sand, Michael, Vieta, Eduard, McGuire, Philip, Arango, Celso, Shin, Jae Il, Fusar-Poli, Paolo
Format:	Journal Article
Language:	English
Published:	Elsevier B.V 01-11-2021
Subjects:	Depression Medicin och hälsovetenskap Prevention, Evidence, Prediction, Meta-analysis Depression Prevention, Evidence, Prediction, Meta-analysis
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Summary:	•This systematic meta-review provides a comprehensive, evidence-based appraisal of the efficacy of preventive interventions for depression.•87.2% of the interventions were significantly superior to the control condition for depressive symptoms; 75% of the interventions were significantly superior to the control condition for depressive disorder onset.•Preventive selective serotonin reuptake inhibitors (SSRIs) for individuals with a stroke had high credibility to prevent depressive disorders.•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.•SSRIs may be offered to individuals who have suffered a stroke.•Psychosocial interventions might be offered to young people at risk or during the prenatal/perinatal period, depending on professional judgment and patient preferences.•Moderate-high quality meta-analyses have been conducted in the primary prevention of depression field. However, the credibility for most interventions is insufficient/too low to recommend their systematic implementation. 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	0165-0327 1573-2517 1573-2517
DOI:	10.1016/j.jad.2021.07.101