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Psychological, educational interventions in primary care setting show benefit in preventing depression

Educational interventions — those that provide information through lectures or fact sheets as well as psychological interventions — those that attempt to change how people think by using techniques such as cognitive behavioral or interpersonal therapy, to prevent depression, had a modest but significant preventive effect in primary care, according to a systematic review and meta-analysis recently published in Annals of Family Medicine.

According to researchers, the average 12-month prevalence of major depression is 11% in primary care, compared with 5% overall. In terms of global disease burden measured in disability-adjusted life years, they stated that major depressive disorder increased by 37% between 1990 and 2010 and is projected to become the leading cause of disease burden by 2030 in high-income countries.

“Primary health care services are the ideal setting in which to undertake disease prevention strategies for many illnesses, including depression. At the patient level, many people at risk of depression are seen in general practice. At the population level, primary care serves defined communities, so that prevention can be population based,” Sonia Conejo-Cerón, PhD, Unidad de Investigación Distrito de Atención Primaria, Málaga, Spain, and colleagues wrote. “Although some trials for primary prevention of depression in primary care have been undertaken, no systematic review or meta-analysis of these trials has yet been conducted.”

Conejo-Cerón and colleagues analyzed 14 studies (13 of which were valid for meta-analysis) found by searching MEDLINE, Cochrane Central Register of Controlled Trials, OpenGrey Repository, Web of Science and PsycINFO. The studies involved 7,365 patients.

Care management strategies found in the studies included problem solving therapy, placebo plus clinical management, biopsychosocial intervention, care as usual, cognitive behavioral approach, person centered approach, psychoeducational, cognitive behavioral therapy, encouraging personal resources, social support, waiting lists, no intervention or information by videotape, and stepped care programs. Only randomized clinical trials that excluded depression at baseline were included.

Researchers found that in only four of the randomized clinical trials, the intervention clinicians were primary care staff, and their pooled effect (Standard Mean Difference = -0.197) was not different when compared to other mental health providers (Standard Mean Difference = 0.141).The pooled standard mean difference, determined by using a random effects model, was –0.163 (95% CI; –0.256 to –0.07; P = .001). The risk of bias and the heterogeneity (I² = 20.6%) were low, and there was no evidence of publication bias. In addition, meta-regression detected no association between standardized mean difference and follow-up times or standardized mean difference and risk of bias. A subgroup analysis suggested greater effectiveness when the randomized clinical trials used care as usual as the comparator compared with those using placebo.

“According to our results, primary care managers and physicians could implement programs and interventions to prevent depression,” Conejo-Cerón and colleagues wrote. “Not enough information is available, however, about what program or intervention is more efficient in primary care.” – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.