Prevention of the onset of Depression

depression prevention

Methods for preventing the onset of new cases of depression are manifold. The most researched prevention methods are:

  • Cognitive Behavioral Therapy, the number of sessions can vary from 6-15 sessions. It can be given in a group or individual treatment.
  • Problem Solving. In short: Problem solving treatment has three main steps: patients’ symptoms are linked with their problems, problems are defined and clarified, and an attempt is made to solve the problems in a structured way. See also BMJ. It is usually done by primary physicians and nurses.
  • Psychoeducation emphasizes instruction not therapy and promotes relaxation, positive thinking, pleasant activities, and social skills. It can be done in a group or with individuals, the number of sessions can vary between 4-12.
  • Interpersonal therapy is a time-limited psychotherapy that focuses on the interpersonal context and on building interpersonal skills. IPT is based on the belief that interpersonal factors may contribute heavily to psychological problems. It is commonly distinguished from other forms of therapy in its emphasis on the interpersonal rather than the intrapsychic. Individual and/or group sessions varying from 6-15.
  • Social support is the physical and emotional comfort given to us by our family, friends, co-workers and others. In this form of treatment these forms of support are clarified and expanded or improved.
  • Any combination of these treatments

Prevention has been examined in a considerable number of intervention studies, but only a small proportion of these have focused on possibilities for actually preventing the onset of new cases of mental disorders. In a recent meta-analysis 19 studies could be included.

The number needed to treat to prevent one case of depressive disorder was 22. This means that 22 individuals have to be treated with a prevention treatment before 1 won’t have an onset of a depressive disorder.

There are three types of prevention:

  • Universal prevention, such as school programs and mass media campaigns, aimed at the general population or segments of the general population, regardless of whether they have a higher-than-average risk of developing a disorder
  • Selective prevention, aimed at individuals in high-risk groups who have not yet developed a mental disorder such as post partum women, stroke patients.
  • Indicated prevention, aimed at individuals who have some symptoms of a mental disorder but do not meet diagnostic criteria.

In this systematic review

Two of the 21 contrast groups we included in our meta-analysis examined universal prevention, 11 examined selective prevention, and eight examined indicated prevention. Fifteen interventions were cognitive-behavioral therapy (CBT), three were interpersonal psychotherapy,
and the remaining were other types of intervention (one-session debriefing; problem-solving; and
mutual support).

Not the type of prevention but prevention based on interpersonal psychotherapy may be more effective than prevention based on cognitive-behavioral therapy. Target population such as post partum women or adolescents did not influence the outcome of a prevention strategy.

The authors state in their article:

………the numbers needed to treat seem to be rather high (22 in the overall analysis). On the other hand, there are no clear guidelines for what is a high number needed to treat and what is not. For example, the regular use of aspirin to reduce the risk of heart attack has become common practice, and the number needed to treat has been found to be 130. The number needed to treat associated with the use of cyclosporine in the prevention of organ rejection has been found to be 6.3 and is considered a medical breakthrough of considerable practical importance.

What do you think is treating 22 individuals with a prevention program to prevent the onset of depression in one of them worth the time and money? Selective- and indicated prevention have lower numbers of needed to treat respectively 16 and 17.

Limitations of this study:

  • Small number of studies (19)
  • Quality of studies not all optimal
  • Limited follow-up, max 2 years
Pim Cuijpers, Ph.D., Annemieke van Straten, Ph.D., Filip Smit, Ph.D., Cathrine Mihalopoulos,, B.B.Sc.(Hons), Aartjan Beekman, M.D., Ph.D. (2008). Preventing the Onset of Depressive Disorders: A Meta-
Analytic Review of Psychological Interventions American Journal of Psychiatry, 165, 1272-1280 DOI: 18765483