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Cognitive behavioural therapy can help to prevent depression

Bellon JA, Morena-Peral P, Motrico E, et al. Effectiveness of psychological and/or educational interventions to prevent the onset of episodes of depression: A systematic review of systematic reviews and meta-analyses Prev Med. 2015;76:S22–S32.

Review question

Do psychological approaches (eg. cognitive behavioural therapy) and educational approaches help prevent depression?

Background

Depression is a major issue in many countries and is projected to be the greatest contributor to burden of illness in high-income countries by 2030. It is more advantageous to prevent rather than treat depression and there have been hundreds of studies and dozens of systematic reviews published on the topic.  This systematic review of systematic reviews was conducted to compare the findings.  

How the review was done

The review included 5 systematic reviews and 7 meta-analyses published between 2006 and 2014, including 156 randomized controlled trials and over 56,000 participants. All included systematic reviews and meta-analyses were of good quality.

Key features of studies included in this review:

• None of the participants had a diagnosis of depression at the start of the study.
• Participants took part in cognitive behavioural therapy or other types of therapy, counselling, self-help or received education and support, most provided by mental health specialists.  
• Researchers measured the number of people who were diagnosed with depression and/or depressive symptoms during the study period. 
• Results were compared with people in control groups who either received the usual care, other types of support, or were on a wait list.

What the researchers found

Cognitive behavioural therapy and other psychological or educational approaches had a small to moderate impact on preventing depression. These results however, included people with depression symptoms. When the results were limited to studies that only included participants without depression symptoms, the benefits of therapy were even greater. The populations, settings, and types of approaches varied widely. Cognitive behavioural therapy was the most common approach.  More research is needed to learn more about the cost-effectiveness of depression prevention programs, the best approaches and populations to prioritize.

Conclusion

Depression prevention programs – using cognitive behavioural therapy and other psychological and educational approaches – show promise as effective ways to prevent depression in adults.