Primary prevention of depression: An umbrella review of controlled interventions

G.S. de Pablo, M. Solmi, J. Vaquerizo-Serrano, J. Radua, A. Passina, P. Mosillo, C.U. Correll, S. Borgwardt, S. Galderisi, A. Bechdolf, A. Pfennig, M. Bauer, L.V. Kessing, T. van Amelsvoort, D.H. Nieman, K. Domschke, M.O. Krebs, M. Sand, E. Vieta, P. McGuireC. Arango, J. Il Shin, P. Fusar-Poli*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review


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.
Original languageEnglish
Pages (from-to)957-970
Number of pages14
JournalJournal of Affective Disorders
Publication statusPublished - 1 Nov 2021


  • Depression
  • Prevention
  • Evidence
  • Prediction
  • Meta-analysis

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