Randomized Clinical Trials to Prevent Depression in Primary Care
| Author, Year Country | Target Population, Type of Prevention | Inclusion Criteria | Sample (Control/Intervention) No. | Care Management | Intervention Orientation (No. of Sessions/Format) | Clinician | Main Outcome | Follow-up | Risk of Biasa |
|---|---|---|---|---|---|---|---|---|---|
| Barrett et al,49 2001b (United States) | Adults (18–59 y) Indicatedc | Minor depression (HRSD ≥10; PRIME-MD) | 74 (38/36) | 1. PST-PC 2. Placebo plus clinical management | CB (6/individual) | Psychologists | Depressive symptoms (HSCL-D-20 depression scale) | 11 wk | 1 (llulll) |
| Bellón et al,47 2016 (Spain) | Adults (18–75 y) Universald | No MD in past 6 mo (CIDI) | 3,326 (1,663/1,663) | 1. Biopsychosocial intervention 2. CAU | Biopsychosocial personalized (3/individual) | Primary care physicians who received a 10- to 15-h training workshop | Incidence MD (CIDI) | 6-12-18 mo | 2 (llhlll) |
| Brugha et al,44 2011 (United Kingdom) | Women postnatally Selectivee | No depression (EPDS <12) | 2,241 (767/1,474) | 1. CBA/PCA 2. CAU | CBA/PCA (8/individual) | Community nurse (health visitor) with 6 half-days training and access to regular supervision sessions | Proportion of women scoring ≥12 EPDS | 6-12-18 mo | 5 (luhhll) |
| Brugha et al,45 2016 (United Kingdom) | Pregnant women Selectivee | No depression (EPDS <12) | 186 (83/103) | 1. CBA 2. CAU | CBA (3/individual) | Community midwife with 8-d training in psychological care (1 d exclusively in the use of the EPDS) | Proportion of women scoring ≥12 EPDS | 22 wk | 4 (llhlhl) |
| Frank et al,38 2002b (United States) | Adults (≥18 y) Indicatedc | Minor depression (HRSD ≥10; PRIME-MD) | 168 (89/79) | 1. PST-PC 2. Placebo plus clinical management | CB (6/individual) | Psychologists, social workers, counselors | Depressive symptoms (HSCL-D-20 depression scale) | 11 wk | 3 (llulhl) |
| García-Campayo et al,43 2010 (Spain) | Adults (18–65 y) Selectivee | No DSM-IV Axis I psychiatric disorders (SPPI) | 104 (52/52) | 1. Psychoeducational 2. No intervention | Psychoeducational and CB (5/group) | Primary care physicians with specific training in mental health and group therapy | Prevalence of somatoform disorders (SPPI) | 3-6-60 mo | 3 (llhlul) |
| Gillham et al,40 2006 (United States) | Early adolescents (11–12 y) Indicatedc | No MD (CDI ≥7/9; DICA-R) | 271 (124/147) | 1. CBT (PRP) 2. CAU | CB (12/group) | Child psychologists, child social workers | Depressive symptoms (CDI) | 6-12-18-24 mo | 7 (lhhhul) |
| González et al,50 2006 (Spain) | Adults (25–55 y) Indicatedc | No depressive disorder (DSM-IV) | 60 (NR/NR) | 1. CBT 2. Encouraging personal resources 3. Social support 4. Waiting list | CB (6/group) | Psychologists | Depressive symptoms (BDI) | 6-12 mo | 9 (uhhhhl) |
| Lynch et al,37 1997 (United States) | Adults (≥18 y) Indicatedc | Minor depression (MOS Depression Screening Inventory >cutoff; DIS) | 29 (14/15) | 1. PST 2. CAU | CB (6/individual by telephone) | Student therapist, medical student, graduate nursing student | Depressive symptoms (BDI) | 7 wk | 7 (uhhlhl) |
| Muñoz et al,36 1993–1995 (United States) | Adults (≥18 y) Selectivee | No MD in past 6 months (DIS) | 150 (78/72) | 1. CBT 2. No intervention or information by videotape | CB (8/group) | Psychologists | Incidence of depression (DIS), depressive symptoms (BDI, CES-D) | 6-12 mo | 2 (llhlll) |
| van’t Veer-Tazelaar et al,41,42 2009–2011f (the Netherlands) | Elderly (≥75 y) Indicatedc | Subthreshold depressive symptoms, no MDE (CES-D ≥16; MINI) | 170 (84/86) | 1. Stepped-care program 2. CAU | CB (10/individual) | Home care nurse, specially trained (CBT-bibliotherapy), community psychiatric nurse (CBT + PST), primary care physician to give psychotropic medication (only for participants with continuously elevated CES-D scores) | Cumulative incidence of MDD (MINI) | 6-12-24 mo | 4 (lhhlll) |
| Willemse et al,39 2004 (the Netherlands) | Adults (18–65 y) Indicatedc | Subthreshold depression, no MDD in past 12 mo (CIDI) | 216 (109/107) | 1. CBT 2. CAU | CB (CWD) (7/individual) | Prevention specialist, clinician from a community mental health center | Incidence of depression (CIDI), depressive symptoms (CES-D) | 12 mo | 4 (lhhlll) |
| Williams et al,48 2000b (United States) | Older adults (≥60 y) Indicatedc | Minor depression (HRSD ≥10; PRIME-MD) | 130 (67/63) | 1. PST-PC 2. Placebo plus clinical management | CB (6/individual) | Psychologists, social workers, counselors | Depressive symptoms (HSCL-D-20 depression scale) | 11 wk | 1 (llulll) |
| Zhang et al,46 2014f (China) | Adults (≥18 y) Indicatedc | Subthreshold depression, no MD (CES-D ≥16; SCID) | 240 (119/121) | 1. Stepped-care program 2. CAU | CB (12/individual) | Social workers with at least 3 y counseling experience, primary care physician to give psychotropic medication (only for participants with continuously elevated CES-D scores) or referred to see a psychiatrist | Incidence MD (SCID), depressive symptoms (CES-D) | 3-6-9-12-15 mo | 3 (llhlul) |
BDI = Beck Depression Inventory; CAU = care as usual; CB = cognitive behavioral; CBA = cognitive behavioral approach; CBT = cognitive behavioral therapy; CDI = Children’s Depression Inventory; CES-D = Center for Epidemiologic Studies of Depression; CIDI = Composite International Diagnostic Interview; DICA-R = Diagnostic Inventory for Children and Adolescents; DIS = Diagnostic Interview Schedule; DSM = Diagnostic and Statistical Manual of Mental Disorders; EPDS = Edinburgh Postnatal Depression Scale; HDRS = Hamilton Depression Rating Scale; HSCL-D = Hopkins Symptom Checklist for Depression; MD = major depression; MDD = major depressive disorder; MDE = major depressive episode; MINI = Mini International Neuropsychiatric Interview; MOS = Medical Outcome Study; NR = not reported; PCA = person centered approach; PRIME-MD = The Primary Care Evaluation of Mental Disorders; PRP = Penn Resiliency Program; PST = problem solving therapy; PST-PC = problem solving treatment for primary care; SCID = Structured Clinical Interview for DSM-IV; SPPI = Standardized Polyvalent Psychiatric Interview.
Note: CB, CBA, and CBT focus on the development of personal coping strategies that target solving current problems and changing unhelpful patterns in cognitions (eg, thoughts, beliefs, and attitudes), behaviors, and emotional regulation.
↵a High score means higher risk of bias. Low risk (l) = 0 points; unclear risk (u) = 1 point; or high risk (h) = 2 points; indicate rating of 6 quality criteria: random sequence, allocation concealment, blinding of participants and clinicians, blinding of outcome assessment, incomplete outcome data, selective reporting.
↵b These studies had 3 arms (paroxetine, placebo and problem-solving therapy), but we only used placebo vs problem-solving therapy.
↵c Patients with minor or subthreshold depression.
↵d General population.
↵e Patients with some risk factors for depression.
↵f In these studies, we collected only depression data.