Abstract
Objective: To examine the overall effect of individual depression prevention programs on future likelihood of depressive disorder and reduction in depressive symptoms. In addition, we have investigated whether Cognitive Behavioural Therapy (CBT), Interpersonal Therapy (IPT) and other therapeutic techniques may modify this effectiveness. Methods: This study is based on and includes the trial data from meta-analyses conducted in the Cochrane systematic review of depression prevention programs for children and adolescents by Merry et al. (2011). All trials were published or unpublished English language randomized controlled trials (RCTs) or cluster RCTs of any psychological or educational intervention compared to no intervention to prevent depression in children and adolescents aged 5–19 years. Results: There is some evidence that the therapeutic approach used in prevention programs modifies the overall effect. CBT is the most studied type of intervention for depression prevention, and there is some evidence of its effectiveness in reducing the risk of developing a depressive disorder, particularly in targeted populations. Fewer studies employed IPT, however this approach appears promising. To our knowledge, this is the first study to have explored how differences in the approach taken in the prevention programs modify the overall treatment effects of prevention programs for children and adolescents. Conclusions: More research is needed to identify the specific components of CBT that are most effective or indeed if there are other approaches that are more effective in reducing the risk of future depressive episodes. It is imperative that prevention programs are suitable for large scale roll-out, and that emerging popular modes of delivery, such as online dissemination continue to be rigorously tested.
Highlights
Depressive disorder is a common mental health problem for young people throughout the world.Meta-analyses suggest the prevalence of depressive disorder in children under 13 to be at 2.8%, rising to 5.7% in adolescents [1] and adolescence and young adulthood is the peak period for the emergence of new cases of depression [2]
A recent Cochrane Review undertaken by Merry et al [12] included sixty eight Randomized Controlled Trials (RCTs) of depression prevention programs for children and adolescents
Given the focus on exploring the effectiveness of different types of depression prevention programs, we have described the interventions tested in the trials included in this study below
Summary
Depressive disorder is a common mental health problem for young people throughout the world.Meta-analyses suggest the prevalence of depressive disorder in children under 13 to be at 2.8%, rising to 5.7% in adolescents [1] and adolescence and young adulthood is the peak period for the emergence of new cases of depression [2]. Some interventions are delivered to all participants (a universal approach), whilst others target those at risk of developing depression, for example, those with a depressed caregiver, or those who have some depressive symptoms, but are not yet clinically depressed (a targeted approach). Evidence derived from systematic reviews and meta-analyses of depression prevention programs suggest that the outcomes with regard to depression prevention are promising, but highlight that in most cases this is only in terms of reducing levels of depressive symptoms, and only in some cases, episodes of clinically significant depression [7,8,9,10,11]. The findings indicate a small but significant effect size suggesting small but positive effects in reducing depressive symptoms, and future clinically significant episodes of depression up to 12 months after the intervention is delivered. It has been difficult to show effect when effectiveness rather than efficacy studies are conducted [13,14]
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