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Evidence summaries

Psychological Interventions for the Prevention of Depression in Children and Adolescents

Targeted depression prevention programmes compared with no intervention may reduce clinically significant depressive episodes in children and adolescents. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 83 studies with children and adolescents. The majority of trials (67) were carried out in school settings, 4 in clinical settings, 3 in the community and 4 in mixed settings. 29 trials were carried out in unselected populations and 53 in targeted populations. For the primary outcome of depression diagnosis at medium-term follow-up (up to 12 months), the risk of having a diagnosis of depression was reduced with an intervention compared to no intervention (risk difference (RD) -0.03, 95% CI -0.05 to -0.01; P value = 0.01; 32 trials, n=5 965, moderate quality evidence). Depression symptoms (self-rated) reduced slightly at the post-intervention time point (standardised mean difference (SMD) -0.21, 95% CI -0.27 to -0.15; P value < 0.0001; 70 trials, n=13 829). This effect persisted up to 3 months (SMD -0.31, 95% CI -0.45 to -0.17; P value < 0.0001; 16 studies, n=1558) and 4 to 12 months (SMD -0.12, 95% CI -0.18 to -0.05; P value = 0.0002; 53 studies, n =11 913), but was no longer evident at the long-term follow-up (moderate quality evidence). For trials implemented in universal populations there was no effect for depression diagnosis (RD -0.01, 95% CI -0.03 to 0.01) and a small effect for depression symptoms (SMD -0.11, 95% CI -0.17 to -0.05). For trials implemented in targeted populations there was a statistically significantly beneficial effect of intervention (depression diagnosis RD -0.04, 95% CI -0.07 to -0.01; depression symptoms SMD -0.32, 95% CI -0.42 to -0.23).

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and lack of blinding), and by inconsistency (unexplained variability in results).

    References

    • Merry SN, Hetrick SE, Cox GR et al. Psychological and educational interventions for preventing depression in children and adolescents. Cochrane Database Syst Rev 2011;(12):CD003380 [Assessed as up-to-date: 11 September 2015]. [PubMed]

Primary/Secondary Keywords