Intervention to Prevent Major Depression in Primary Care: A Cluster Randomized Trial

Ann Intern Med. 2016 May 17;164(10):656-65. doi: 10.7326/M14-2653. Epub 2016 Mar 29.


Background: Not enough is known about universal prevention of depression in adults.

Objective: To evaluate the effectiveness of an intervention to prevent major depression.

Design: Multicenter, cluster randomized trial with sites randomly assigned to usual care or an intervention. ( NCT01151982).

Setting: 10 primary care centers in each of 7 cities in Spain.

Participants: Two primary care physicians (PCPs) and 5236 nondepressed adult patients were randomly sampled from each center; 3326 patients consented and were eligible to participate.

Intervention: For each patient, PCPs communicated individual risk for depression and personal predictors of risk and developed a psychosocial program tailored to prevent depression.

Measurements: New cases of major depression, assessed every 6 months for 18 months.

Results: At 18 months, 7.39% of patients in the intervention group (95% CI, 5.85% to 8.95%) developed major depression compared with 9.40% in the control (usual care) group (CI, 7.89% to 10.92%) (absolute difference, -2.01 percentage points [CI, -4.18 to 0.16 percentage points]; P = 0.070). Depression incidence was lower in the intervention centers in 5 cities and similar between intervention and control centers in 2 cities.

Limitation: Potential self-selection bias due to nonconsenting patients.

Conclusion: Compared with usual care, an intervention based on personal predictors of risk for depression implemented by PCPs provided a modest but nonsignificant reduction in the incidence of major depression. Additional study of this approach may be warranted.

Primary funding source: Institute of Health Carlos III.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Depressive Disorder, Major / epidemiology
  • Depressive Disorder, Major / prevention & control*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Primary Health Care / methods*
  • Risk Assessment / methods
  • Spain / epidemiology

Associated data