Attempting to prevent depression in youth: a systematic review of the evidence

Abstract

Aim: The aim of this review was to update the information on prevention and early intervention programmes for depression in adolescents. Method: We searched the literature to the end of July 2006 for published randomized controlled trials of psychological interventions specifically designed to prevent the onset of depression among children and adolescents (aged 5 to 19 years) who did not already meet the criteria for a clinical diagnosis of depressive illness. Results: Findings have been mixed. Positive results after intervention and at follow-up have been reported in a number of targeted studies, although an attempt to replicate findings in a school and in a primary care setting were unsuccessful. Most studies of universal interventions have shown a short-term effect that did not persist at follow-up. There are a number of methodological problems with studies to date. Issues that have not been addressed include taking into account the placebo effect, measuring the incidence of depressive disorder following intervention and ensuring the quality and fidelity of intervention is adequate. Interventions to date may have been too short to create durable change. Conclusions: There is no clear evidence to date that depression prevention is effective and implementation of depression prevention programmes would be premature on current evidence. However, given the positive finding in some studies, and the cost of depressive disorder, further research is warranted. Attempts to reduce depressive disorder in the community should address wider social issues, as well as improving on the narrower interventions focusing on individual protective and risk factors.