Primary prevention of depression: An umbrella review of controlled interventions

Gonzalo Salazar de Pablo, Marco Solmi, Julio Vaquerizo-Serrano, Joaquim Radua, Anastassia Passina, Pierluca Morsillo, 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 McGuireCelso Arango, Jae Il Shin, Paolo Fusar-Poli

Research output: Contribution to journalReview articlepeer-review

23 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)957-970
Number of pages14
JournalJournal of affective disorders
Publication statusPublished - 2021 Nov 1

Bibliographical note

Publisher Copyright:
© 2021 The Authors

All Science Journal Classification (ASJC) codes

  • Clinical Psychology
  • Psychiatry and Mental health


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