Primary prevention of depression: An umbrella review of controlled interventions

Gonzalo Salazar de Pablo; Marco Solmi; Julio Vaquerizo-Serrano; Joaquim Radua; Anastassia Passina; Pierluca Mosillo; Christoph U Correll; Stefan Borgwardt; Silvana Galderisi; Andreas Bechdolf; Andrea Pfennig; Michael Bauer; Lars Vedel Kessing; Therese van Amelsvoort; Dorien H Nieman; Katharina Domschke; Marie-Odile Krebs; Michael Sand; Eduard Vieta; Philip McGuire; Celso Arango; Jae Il Shin; Paolo Fusar-Poli

doi:10.1016/j.jad.2021.07.101

Primary prevention of depression: An umbrella review of controlled interventions

J Affect Disord. 2021 Nov 1:294:957-970. doi: 10.1016/j.jad.2021.07.101. Epub 2021 Jul 31.

Authors

Gonzalo Salazar de Pablo¹, Marco Solmi², Julio Vaquerizo-Serrano³, Joaquim Radua⁴, Anastassia Passina⁵, Pierluca Mosillo⁵, Christoph U Correll⁶, Stefan Borgwardt⁷, Silvana Galderisi⁸, Andreas Bechdolf⁹, Andrea Pfennig¹⁰, Michael Bauer¹⁰, Lars Vedel Kessing¹¹, Therese van Amelsvoort¹², Dorien H Nieman¹³, Katharina Domschke¹⁴, Marie-Odile Krebs¹⁵, Michael Sand¹⁶, Eduard Vieta¹⁷, Philip McGuire¹⁸, Celso Arango¹⁹, Jae Il Shin²⁰, Paolo Fusar-Poli²¹

Affiliations

¹ Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Institute of Psychiatry and Mental Health. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
² Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychiatry, University of Ottawa; Department of Mental Health, The Ottawa Hospital.
³ Institute of Psychiatry and Mental Health. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁴ Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERSAM, Barcelona, Catalonia, Spain; Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden.
⁵ Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
⁶ The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA; Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany.
⁷ Department of Psychiatry, University of Basel, Switzerland; Department of Psychiatry, Psychosomatics and Psychotherapy, University of Lübeck, Lübeck, Germany.
⁸ Department of Psychiatry, University of Campania L. Vanvitelli, Naples, Italy.
⁹ Department of Psychiatry, Psychotherapy and Psychosomatic Medicine with Early Intervention and Recognition Centre (FRITZ), Vivantes Klinikum Am Urban, Charité-Universitätsmedizin, Berlin, Germany; Vivantes Klinikum im Friedrichshain, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Charité-Universitätsmedizin, Berlin, Germany; Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; ORYGEN, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.
¹⁰ Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
¹¹ Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
¹² Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht, The Netherlands.
¹³ Amsterdam University Medical Centers (location AMC), Department of Psychiatry, Amsterdam, Netherlands.
¹⁴ Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Basics in NeuroModulation (NeuroModul), Medical Faculty, University of Freiburg, Germany.
¹⁵ INSERM, IPNP UMR S1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université de Paris, CNRS, GDR3557-Institut de Psychiatrie Paris, France; Faculté de Médecine Paris Descartes, GHU Paris - Sainte-Anne, Pole PEPIT Paris, France.
¹⁶ Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut.
¹⁷ Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
¹⁸ Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK; OASIS service, South London and Maudsley NHS Foundation Trust, London, UK.
¹⁹ Institute of Psychiatry and Mental Health. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain.
²⁰ Department of Paediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.
²¹ Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK; OASIS service, South London and Maudsley NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. Electronic address: paolo.fusar-poli@kcl.ac.uk.

PMID: 34375224
DOI: 10.1016/j.jad.2021.07.101

Abstract

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.

Keywords: Depression; Prevention, Evidence, Prediction, Meta-analysis.

Publication types

Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Adolescent
Adult
Child
Depression*
Female
Humans
Male
Primary Health Care
Primary Prevention
Selective Serotonin Reuptake Inhibitors*
Young Adult

Substances

Serotonin Uptake Inhibitors