Depression Prevention Research Research Articles

Self-understanding, envisioning the future, and prevention: An appreciation and a reflection on the occasion of the 100th anniversary.

On the 100th birthday of the Global Alliance for Behavioral Health and Social Justice, it is appropriate to reflect on the evolution of thought on depression prevention research, as seen through a historical perspective, to note how the field has grown and how it can address the issues of today. This article is a personal reflection on one practitioner's evolution of thought on resilience and preventive intervention, starting with interviewing civil rights workers, to conceptualizing self-understanding as an essential component of resilience, to the development of a family-based preventive intervention for parental depression, which was disseminated, adapted, and incorporated into a growing body of prevention research. Consensus statements on mental health prevention from the National Academies are reviewed, and the importance of a social justice perspective is highlighted throughout. The article concludes with principles for developing effective preventive interventions to promote mental health today, and in the future. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Leading the charge toward a world without depression: perinatal depression can be prevented.

This manuscript is based on a keynote address presented at the 2020 Marcé Society's Conference celebrating the Society's 40th anniversary. The address described a 50-year perspective on prevention research, current evidence that perinatal depression can be prevented, and how digital tools could be used to disseminate perinatal depression prevention interventions throughout the world. We utilized the Mothers and Babies Course as a case study to illustrate these goals. The article reviews the gradual progress of depression prevention research, from the time when the state of the science was such that it was believed that the onset of major depressive episodes could not be prevented until the present day. In addition, the article recounts the three consensus reports on prevention of mental disorders published by the National Academies of Science, Engineering, and Medicine, culminating in the 2019 report, which calls on the field to implement known interventions for the prevention of depression and other mental disorders, and to scale up their administration to reduce the prevalence of these disorders in the general population. The paper presents the 2019 recommendations of the US Preventive Services Task Force, which instructs the health system to provide routine referrals to perinatal depression prevention interventions (e.g., the Mothers and Babies Course) to perinatal persons at risk for depression. We now have the knowledge to prevent approximately half of episodes of perinatal depression. It is time to implement this knowledge and begin to do research on how to prevent the remaining half.

Treatment Considerations for Depression Research in Older Married Couples: A Dyadic Case Study

Critical gaps remain in understanding optimal approaches to intervening with older couples. The focus of this report is to describe the pros and cons of incorporating spousal dyads into depression-prevention research. In an intervention development study, the authors administered problem-solving therapy (PST) dyadically to participants with mild cognitive impairment (MCI) and their caregivers. Dyads worked with the same interventionist in the same therapy session. The dyadic PST (highlighted in a case example of a husband with MCI and his wife/support person) and the potential feasibility of the program are described. The authors found that the wife of the individual with MCI could be trained as a PST coach to help her husband learn and use problem-solving skills. A decrease in depressive symptom severity was observed for the individual with MCI, which was sustained over 12 months of follow-up. Neither the husband nor wife experienced an incident episode of major depression over the course of the study. Dyadic interventions need to be further developed in geriatric psychiatry; proven methods such as PST can be modified to include patients' support persons. Recommendations are offered for developing randomized controlled trials that aim to recruit dyads and prevent depression in at-risk older married couples.

Challenges and Solutions for Depression Prevention Research: Methodology for a Depression Prevention Trial for Older Adults with Knee Arthritis and Emotional Distress

To describe the methodology, challenges, and baseline characteristics of a prevention development trial entitled "Reducing Pain, Preventing Depression." A sequential multiple assignment randomized trial (SMART) compared sequences of cognitive behavioral therapy (CBT) and physical therapy for knee pain and prevention of depression and anxiety. Participants were randomized to CBT, physical therapy, or enhanced usual care and followed for 12 months for new-episode depression or anxiety. Participants were age ≥ 60 with knee osteoarthritis and subsyndromal depression, defined as 9-item Patient Health Questionnaire (PHQ-9) score ≥1 (which included the endorsement of one of the cardinal symptoms of depression [low mood or anhedonia]) and no diagnosis of major depressive disorder per the Structured Clinical Interview for DSM-IV. Depression and anxiety severity and characterization of new episodes were assessed with the PHQ-9, Generalized Anxiety Disorder-7, and the PRIME-MD. Knee pain was characterized with the Western Ontario McMaster Arthritis Index. Response was defined as at least "Very Much Better" on a Patient Global Impression of Change. At baseline there were 99 patients with an average age of 71; 61.62% were women and 81.8% white. The average PHQ-9 was 5.6 and average Generalized Anxiety Disorder-7, was 3.2. Most were satisfied with the interventions and study procedures. The challenges and solutions described here will also be used in a confirmatory clinical trial of efficacy. A SMART design for depression and anxiety prevention, using both CBT and physical therapy, appears to be feasible and acceptable to participants. The methodologic innovations of this project may advance the field of late-life depression and anxiety prevention.

GROUP-BASED SYMPTOM TRAJECTORIES IN INDICATED PREVENTION OF ADOLESCENT DEPRESSION.

Adolescent depression prevention research has focused on mean intervention outcomes, but has not considered heterogeneity in symptom course. Here, we empirically identify subgroups with distinct trajectories of depressive symptom change among adolescents enrolled in two indicated depression prevention trials and examine how cognitive-behavioral (CB) interventions and baseline predictors relate to trajectory membership. Six hundred thirty-one participants were assigned to one of three conditions: CB group intervention, CB bibliotherapy, and brochure control. We used group-based trajectory modeling to identify trajectories of depressive symptoms from pretest to 2-year follow-up. We examined associations between class membership and conditions using chi-square tests and baseline predictors using multinomial regressions. We identified four trajectories in the full sample. Qualitatively similar trajectories were found in each condition separately. Two trajectories of positive symptom course (low-declining, high-declining) had declining symptoms and were distinguished by baseline symptom severity. Two trajectories of negative course (high-persistent, resurging), respectively, showed no decline in symptoms or decline followed by symptom reappearance. Participants in the brochure control condition were significantly more likely to populate the high-persistent trajectory relative to either CB condition and were significantly less likely to populate the low-declining trajectory relative to CB group. Several baseline factors predicted trajectory classes, but gender was the most informative prognostic factor, with males having increased odds of membership in a high-persistent trajectory relative to other trajectories. Findings suggest that CB preventive interventions do not alter the nature of trajectories, but reduce the risk that adolescents follow a trajectory of chronically elevated symptoms.

A Cognitive Behavioral Depression Prevention Program For Early Adolescents

The aim of this study was to present results of our one year experience with Cognitive Behavioral Psychology Program, in order to contribute to the building of whole school approach and positive psychology preventive mental health problems model. Based on Penn Resilience program (PRP), we modify and create program for early adolescents: how to prevent depression and to develop resilience. The program should promote optimism and reduce depression in children. Our focus was on explanatory style and optimism. Program’s goal is not simply to teach “positive thinking”. The goal is realistic thinking. During one academic year we have implemented this program in four classes in one primary school in Stip, R. Macedonia. One hundredth and twenty, eight grade’s adolescents, at the age of 14 years, 56 boys, 64 girls, were involved. We conducted a pre & post survey. Children’s Attribution Style Questionnaire (CASQ, Seligman et al.,1995), was used in order to measure the optimistic and pessimistic level among students. According to the results gathered by the pre & post survey, we can see that there exist some changes in the children’s optimistic and pessimistic level. Depression prevention research will live up to its promise if interventions like PRP can be successfully implemented by schools, clinics, and other community settings.

The Public Health Impact of Major Depression: A Call for Interdisciplinary Prevention Efforts

Major depression is a consequential public health problem in the United States. Depression has long been recognized as an important target of intervention in psychology and psychiatry, but these fields have focused efforts primarily on treatment rather than prevention. Although effective preventive interventions targeting high-risk groups have been developed, they have thus far had poor reach and sustainability in the community. The development of sustainable preventive interventions that have the potential to impact population health represents a critical goal for the field. To this end, a research agenda incorporating the perspectives of both mental health disciplines and public health is proposed as a guide for future depression prevention research. Increased interdisciplinary collaboration between mental health disciplines and public health is recommended to develop, enact, and evaluate multilevel preventive interventions aimed at reducing the population health burden of major depression.

Preventing Depression in Later Life: Translation From Concept to Experimental Design and Implementation

The authors detail the public health need for depression prevention research and the decisions made in designing an experiment testing problem solving therapy as "indicated" preventive intervention for high-risk older adults with subsyndromal depression. Special attention is given to the recruitment of African Americans because of well-documented inequalities in mental health services and depression treatment outcomes between races. A total of 306 subjects (half white, half African American) with scores of 16 or higher on the Center for Epidemiological Studies of Depression Scale, but with no history of major depressive disorder in the past 12 months, are being recruited and randomly assigned to either problem solving therapy-primary care or to a dietary education control condition. Time to, and rate of, incident episodes of major depressive disorder are to be modeled using survival analysis. Level of depressive symptoms will be analyzed via a mixed models approach. Twenty-two subjects have been recruited into the study, and to date eight have completed the randomly assigned intervention and postintervention assessment. Four of 22 have exited after developing major depressive episodes. None have complained about study procedures or demands. Implementation in a variety of community settings is going well. The data collected to date support the feasibility of translating from epidemiology to RCT design and implementation of empirical depression prevention research in later life.

Recruiting Latino women in the U.S. and women in Mexico in postpartum depression prevention research

The negative consequences of untreated depression on the health and well-being of women and their children are well-documented, underscoring the need to develop effective interventions to prevent the onset of major depression during the perinatal period. This article describes recruitment data from two randomized controlled trials of preventive interventions for postpartum depression: one conducted with immigrant Latinas in Washington, DC, United States, and the other with women in Mexico City, Mexico. In both countries, pregnant women met a priori eligibility criteria and were randomized into an 8-week theory-based group intervention. Two hundred and seventeen Latinas in the U.S. and 377 women born and raised in Mexico were enrolled in their respective countries. The recruitment rates (i.e., the number of participants who met eligibility criteria, consented, and randomized into the study) were 70% in the U.S. and in Mexico. Issues and recommendations related to recruiting Hispanic women into preventive intervention trials for postpartum depression are discussed.

Prevention of depression: The state of the science at the beginning of the 21st Century

Major depression is one of the most prevalent mental disorders and the number one cause of disability worldwide. Once a person experiences a major depressive episode (MDE), the likelihood of recurrence is very high. The prevention of first onset, as well as the protection against recurrence after recovery, are therefore essential goals for the mental health field. By the end of the 20th century, however, most depression research efforts had focused on either acute or prophylactic treatment. In this article, we review USA and international studies that have attempted to reduce incidence of MDE, either 1) to prevent onset in populations of children and adults (including women during the postpartum period) not currently meeting diagnostic criteria for depression, or 2) to prevent a new episode in individuals who have recovered after treatment through protective, but not prophylactic interventions. We identified twelve randomized controlled trials focused on preventing the onset of major depression (both MDE and postpartum depression (PPD)), five randomized controlled trials focusing on preventing relapse, and no randomized controlled trials focused exclusively on preventing recurrent episodes through protective interventions. The review is limited in scope given that depression prevention trials focused on infants, young children, and older adults were not included in the review. The research to date suggests that the prevention of major depression is a feasible goal for the 21st century. If depression prevention interventions become a standard part of mental health services, unnecessary suffering due to depression will be greatly reduced. This review concludes with suggestions for the future direction of depression prevention research.

Expanding depression prevention research with children of diverse cultures.

This is a commentary on the articles by E. V. Cardemil, K. J. Reivich, and M. E. P. Seligman (2002) and D. L. Yu and M. E. P. Seligman (2002) in this issue of Prevention & Treatment. Both articles evaluate the Penn Resiliency Program when administered to diverse samples of children. The first study focused on African American and Latino (primarily Puerto Rican) children and the second on Chinese schoolchildren in Beijing. Explanatory style was related to depressive symptoms for the Chinese sample, but not for the African American or Latino samples. The intervention produced a significant reduction in depressive symptoms for the Latino and Chinese samples but not for the African American group. The commentary suggests possible reasons for these discrepancies and highlights the exemplary elements of these benchmark studies.

Expanding depression prevention research with children of diverse cultures.

Expanding depression prevention research with children of diverse cultures.

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

The prevention of major depression is an important research goal which deserves increased attention. Depressive symptoms and disorders are particularly common in primary care patients and have a negative impact on functioning and well-being comparable with other major chronic medical conditions. The San Francisco Depression Prevention Research project conducted a randomized, controlled, prevention trial to demonstrate the feasibility of implementing such research in a public sector setting serving low-income, predominantly minority individuals: 150 primary care patients free from depression or other major mental disorders were randomized to an experimental cognitive-behavioral intervention or to a control condition. The experimental intervention group reported a significantly greater reduction in depressive levels. Decline in depressive levels was significantly mediated by decline in the frequency of negative conditions. Group differences in the number of new episodes (incidence) of major depression did not reach significance during the 1-year trial. We conclude that depression prevention trials in public sector primary care settings are feasible, and that depressive symptoms can be reduced even in low-income, minority populations. To conduct randomized prevention trials that can test effects on incidence with sufficient statistical power, subgroups at greater imminent risk have to be identified.

The prevention of depression: Current research and practice

In 1984, a National Institute of Mental Health public information pamphlet titled Depression: What We Know stated that “In general, the onset of a clinical depression cannot be prevented” ( Lobel & Hirschfeld, 1984, p. 4). This paper examines the current evidence on this question. After the scope of depression prevention research has been specified, studies focused on preventing clinical episodes of depression, preventing high symptom levels, and reducing symptom levels in high-risk groups will be reviewed. This will represent what has been done to date in terms of preventive interventions. Next, several research areas that have potential contributions to make in the quest for future depression prevention strategies will be explored.