Table 2.
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.
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.
These studies had 3 arms (paroxetine, placebo and problem-solving therapy), but we only used placebo vs problem-solving therapy.
Patients with minor or subthreshold depression.
General population.
Patients with some risk factors for depression.
In these studies, we collected only depression data.