Chapter 22 - Could Depression be Preventable? Evidence and Perspectives

Abstract

Prevention is an appealing approach to reducing the burden of many illnesses, including depression. Potentially applicable preventive strategies fall into three categories: primary prevention, secondary prevention, and tertiary prevention. Primary prevention aims to avoid the occurrence of a condition in the first place. Secondary prevention places its emphasis on early detection, and tertiary prevention refers to strategies put in place to diminish the burden of illness after it has already occurred. In keeping with these approaches, it is possible that removal of risk factors will diminish incidence (primary prevention), the discovery of biomarkers will facilitate early intervention (secondary prevention), and some treatments such as cognitive-behavioral therapies and antidepressant medication may reduce rates of recurrence, thereby diminishing morbidity of established disorders (tertiary prevention). Evidence supporting the effectiveness of primary and secondary prevention is nevertheless scarce. Conceivably, there may be underlying qualitative differences between depression and other medical conditions that interfere with the success of primary, secondary, and tertiary preventive interventions. Such characteristics may include the indistinct boundaries between depressive disorders and normal emotional experiences, the role that negative emotions may play in psychological and social functioning, and an inherently weak ability to conceive of depression in terms of pathophysiological processes distinct from a broader psychosocial context. Tertiary prevention continues to receive emphasis in discussions about health policy, but even here, empirical evidence of its success is lacking.