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Ann Fam Med. 2017 May;15(3):262-271. doi: 10.1370/afm.2031.

Effectiveness of Psychological and Educational Interventions to Prevent Depression in Primary Care: A Systematic Review and Meta-Analysis.

Author information

1
Unidad de Investigación, Distrito de Atención Primaria Málaga-Guadalhorce, Málaga, Spain (Conejo-Cerón, Moreno-Peral, Navas-Campaña, Bellón); Red de Investigación en Actividades Preventivas y de Promoción de la Salud (redIAPP), Barcelona, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Motrico, Navas-Campaña, Rigabert, Martín-Pérez, Rodríguez-Bayón, Ballesta-Rodríguez, Luna, García-Campayo, Roca, Bellón); Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Bellón); Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Malaga, Spain (Rodríguez-Morejón); Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain (Motrico, Rigabert); Centro de Salud Marquesado, Área Nordeste de Granada, Granada, Spain (Martín-Pérez); Centro de Salud San José, Linares, Jaén, Spain (Rodríguez-Bayón); Centro de Salud Federico del Castillo, Jaén, Spain (Ballesta-Rodríguez); Departamento de Bioestadística. Universidad de Granada, Granada, Spain (Luna); Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain (Luna); Departamento de Psiquiatría, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain (García-Campayo); Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain (Roca); Centro de Salud El Palo, Málaga, Spain (Bellón); Departamento de Medicina Preventiva, Salud Pública y Psiquiatría, Universidad de Málaga, Málaga, Spain (Bellón). soniafundacionimabis@hotmail.com.
2
Unidad de Investigación, Distrito de Atención Primaria Málaga-Guadalhorce, Málaga, Spain (Conejo-Cerón, Moreno-Peral, Navas-Campaña, Bellón); Red de Investigación en Actividades Preventivas y de Promoción de la Salud (redIAPP), Barcelona, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Motrico, Navas-Campaña, Rigabert, Martín-Pérez, Rodríguez-Bayón, Ballesta-Rodríguez, Luna, García-Campayo, Roca, Bellón); Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Bellón); Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Malaga, Spain (Rodríguez-Morejón); Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain (Motrico, Rigabert); Centro de Salud Marquesado, Área Nordeste de Granada, Granada, Spain (Martín-Pérez); Centro de Salud San José, Linares, Jaén, Spain (Rodríguez-Bayón); Centro de Salud Federico del Castillo, Jaén, Spain (Ballesta-Rodríguez); Departamento de Bioestadística. Universidad de Granada, Granada, Spain (Luna); Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain (Luna); Departamento de Psiquiatría, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain (García-Campayo); Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain (Roca); Centro de Salud El Palo, Málaga, Spain (Bellón); Departamento de Medicina Preventiva, Salud Pública y Psiquiatría, Universidad de Málaga, Málaga, Spain (Bellón).

Abstract

PURPOSE:

Although evidence exists for the efficacy of psychosocial interventions to prevent the onset of depression, little is known about its prevention in primary care. We aimed to evaluate the effectiveness of psychological and educational interventions to prevent depression in primary care.

METHODS:

We conducted a systematic review and meta-analysis of relevant randomized controlled trials (RCTs) examining the effect of psychological and educational interventions to prevent depression in nondepressed primary care attendees. We searched MEDLINE, PsycINFO, Web of Science, OpenGrey Repository, Cochrane Central Register of Controlled Trials, and other sources up to May 2016. At least 2 reviewers independently evaluated the eligibility criteria, extracted data, and assessed the risk of bias. We calculated standardized mean differences (SMD) using random-effects models.

RESULTS:

We selected 14 studies (7,365 patients) that met the inclusion criteria, 13 of which were valid to perform a meta-analysis. Most of the interventions had a cognitive-behavioral orientation, and in only 4 RCTs were the intervention clinicians primary care staff. The pooled SMD was -0.163 (95%CI, -0.256 to -0.070; P = .001). The risk of bias and the heterogeneity (I2 = 20.6%) were low, and there was no evidence of publication bias. Meta-regression detected no association between SMD and follow-up times or SMD and risk of bias. Subgroup analysis suggested greater effectiveness when the RCTs used care as usual as the comparator compared with those using placebo.

CONCLUSIONS:

Psychological and educational interventions to prevent depression had a modest though statistically significant preventive effect in primary care. Further RCTs using placebo or active comparators are needed.

KEYWORDS:

delivery of health care; depression/prevention & control; educational interventions; meta-analysis; primary health care; psychological interventions; systematic review

PMID:
28483893
PMCID:
PMC5422089
DOI:
10.1370/afm.2031
[Indexed for MEDLINE]
Free PMC Article

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