Primary Prevention of Depression: An Umbrella Review of Controlled Interventions,Journal of Affective Disorders

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Primary Prevention of Depression: An Umbrella Review of Controlled Interventions
Journal of Affective Disorders ( IF 6.6 ) Pub Date : 2021-07-31 , DOI: 10.1016/j.jad.2021.07.101
Gonzalo Salazar de Pablo ₁ , Marco Solmi ₂ , Julio Vaquerizo-Serrano ₃ , Joaquim Radua ₄ , Anastassia Passina ₅ , Pierluca Mosillo ₅ , Christoph U Correll ₆ , Stefan Borgwardt ₇ , Silvana Galderisi ₈ , Andreas Bechdolf ₉ , Andrea Pfennig ₁₀ , Michael Bauer ₁₀ , Lars Vedel Kessing ₁₁ , Therese van Amelsvoort ₁₂ , Dorien H Nieman ₁₃ , Katharina Domschke ₁₄ , Marie-Odile Krebs ₁₅ , Michael Sand ₁₆ , Eduard Vieta ₁₇ , Philip McGuire ₁₈ , Celso Arango ₁₉ , Jae Il Shin ₂₀ , Paolo Fusar-Poli ₂₁

Affiliation

Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Institute of Psychiatry and Mental Health. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychiatry, University of Ottawa; Department of Mental Health, The Ottawa Hospital.
Institute of Psychiatry and Mental Health. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERSAM, Barcelona, Catalonia, Spain; Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden.
Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA; Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany.
Department of Psychiatry, University of Basel, Switzerland; Department of Psychiatry, Psychosomatics and Psychotherapy, University of Lübeck, Lübeck, Germany.
Department of Psychiatry, University of Campania L. Vanvitelli, Naples, Italy.
Department of Psychiatry, Psychotherapy and Psychosomatic Medicine with Early Intervention and Recognition Centre (FRITZ), Vivantes Klinikum Am Urban, Charité-Universitätsmedizin, Berlin, Germany; Vivantes Klinikum im Friedrichshain, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Charité-Universitätsmedizin, Berlin, Germany; Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; ORYGEN, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.
Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht, The Netherlands.
Amsterdam University Medical Centers (location AMC), Department of Psychiatry, Amsterdam, Netherlands.
Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Basics in NeuroModulation (NeuroModul), Medical Faculty, University of Freiburg, Germany.
INSERM, IPNP UMR S1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université de Paris, CNRS, GDR3557-Institut de Psychiatrie Paris, France; Faculté de Médecine Paris Descartes, GHU Paris - Sainte-Anne, Pole PEPIT Paris, France.
Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut.
Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK; OASIS service, South London and Maudsley NHS Foundation Trust, London, UK.
Institute of Psychiatry and Mental Health. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain.
Department of Paediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.
Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK; OASIS service, South London and Maudsley NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.

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.

中文翻译：

抑郁症的一级预防：受控干预的总括审查

背景：一级预防有可能改变抑郁症的病程，但这种影响的一致性和程度目前尚未确定。

方法： PRISMA 和 RIGHT 兼容 (PROSPERO:CRD42020179659) 系统性荟萃评论，PubMed/Web of Science，截至 2020 年 6 月。对抑郁症状一级预防的受控干预措施的荟萃分析 [效果测量：标准化平均差 (SMD) ] 或抑郁症 [效果测量：相对风险 (RR)]。结果按以下因素分层：(i) 年龄范围；(ii) 目标人群（一般和/或高危人群）；(iii) 干预类型。评估质量（用 AMSTAR/AMSTAR-PLUS 内容评估）和可信度（分级为高/中/低）。USPSTF 分级系统用于推荐。

结果：包括 46 项荟萃分析（k=928 个人研究，n=286,429 个人，平均年龄=22.4 岁，81.1% 女性）。效果大小为：SMD=0.08-0.53；对于抑郁症状；对于抑郁症，RR=0.90-0.28。仅包括随机对照试验的敏感性分析不影响结果。AMSTAR 中位数=9（IQR=8-9）；AMSTAR-PLUS 含量中位数=4.25（IQR=4-5）。43 项 (93.5%) 荟萃分析的证据可信度不足/低，两项 (4.3%) 为中等，一项 (2.2%) 为高：仅对年轻人使用社会心理干预措施来减轻抑郁症状，并结合使用初级保健中的心理和教育干预措施具有中等可信度；选择性5-羟色胺再摄取抑制剂（SSRIs）预防性给药治疗卒中患者的抑郁症具有很高的可信度。

局限性：干预异质性和缺乏长期疗效评估。

结论：抑郁症的初级预防干预可能是有效的。其中，临床医生可能会在卒中后提供 SSRI 以预防抑郁症，并为有危险因素的儿童/青少年/年轻人或在产前/围产期提供社会心理干预。

更新日期：2021-08-01

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