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Predictors of efficacy in depression prevention programmes: Meta-analysis

  • Eva Jané-Llopis (a1), Clemens Hosman (a1), Rachel Jenkins (a2) and Peter Anderson (a3)
Abstract
Background

Worldwide, 340 million people are affected by depression, with high comorbid, social and economic costs.

Aims

To identify potential predictors of effect in prevention programmes.

Method

A meta-analysis was made of 69 programmes to reduce depression or depressive symptoms.

Results

The weighted mean effect size of 0.22 was effective for different age groups and different levels of risk, and in reducing risk factors and depressive or psychiatric symptoms. Programmes with larger effect sizes were multi-component, included competence techniques, had more than eight sessions, had sessions 60–90 min long, had a high quality of research design and were delivered by a health care provider in targeted programmes. Older people benefited from social support, whereas behavioural methods were detrimental.

Conclusions

An 11% improvement in depressive symptoms can be achieved through prevention programmes. Single trial evaluations should ensure high quality of the research design and detailed reporting of results and potential predictors.

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Copyright
Corresponding author
Dr Eva Jané-Llopis, Department of Clinical Psychology and Personality, University of Nijmegen, PO Box 9104, 6500HE Nijmegen, The Netherlands. E-mail: llopis@psych.kun.nl
Footnotes
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Declaration of interest

None. Funding detailed in Acknowledgements.

Footnotes
References
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Predictors of efficacy in depression prevention programmes: Meta-analysis

  • Eva Jané-Llopis (a1), Clemens Hosman (a1), Rachel Jenkins (a2) and Peter Anderson (a3)
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Premature conclusions

Christine Kuehner, research psychologist
19 November 2003

To my opinion, the meta-analysis by Jane-Llopis and colleagues (Br J Psychiatry, 183, 384-397) suffers from some methodological flaws that misguided the authors to draw premature conclusions on predictors of prevention in depression prevention programmes. Firstly, many of the selected studies did not target the prevention of depression but examined therapeutic or preventive strategies for other primary disorders and used depression scores as secondary outcome measures. For example, Bisson et al. (1997) studied the efficacy of psychological debriefing (PD) on the development of posttraumatic stress disorder (PTSD) in victims of acute burn traumas and showed that PD may even worsen the long-term course of victims. But while PD may have been mistakenly considered as helpful for preventing PTSD in the past, no reasonable therapist or researcher has ever claimed that massive emotionalconfrontation would represent a promising strategy for depression or depression prevention.Secondly, the codings of respective methods look rather inconsistent, and I was wondering how the authors were able to reach such a high interrater reliability across codes. For example, the PD method by Bisson et al. (1997) was coded as “behavioural, cognitive and educational” (p. 389), while the code “cognitive” was missing for Seligman’s intervention based on cognitive therapy (!). Similarly, four research groups using similar variants of the “Coping with Depression Course” by Lewinsohn et al. (1984)were coded differently (e.g., “cognitive and competence”, “behavioural, cognitive, educational and social support”, “cognitive”, and “behavioural, cognitive, competence and educational” (pp. 386ff.). Finally, their coding category “behavioural methods” incorporates very heterogeneous strategies. For example, behavioural strategies found to be helpful in CBT for depression focus on increasing pleasant activities and social skills training (Lewinsohn et al., 1984), while, on the other hand,the delivery of peer support telephone dyads by lay persons, as used in the studies by Heller et al. (1991), may be regarded as a very specific behavioural strategy which has so far not been recommended as a helpful intervention by the research community. In the present meta-analysis, respective interventions from the studies by Heller et al. (1991) had negative effect sizes and therefore may have substantially accounted for the missing or even negative effect of the “behavioural” component of preventive measures.

ReferencesBisson, J. I., Jenkins, P. L., Alexander, J., et al (1997) Randomised controlled trial of psychological debriefing for victims of acute burn trauma. British Journal of Psychiatry, 171, 78 –81. Heller, K., Thompson, M.G., Trueba, P.E., et al. (1991) Peer support telephone dyads for elderly women: was this the wrong intervention? American Journal of Community Psychology, 19, 53-74.Jane-Llopis, E., Hosman, C., Jenkins, R. & Anderson, P. (2003) Predictors of efficacy in depression prevention programmes. Meta analysis.British Journal of Psychiatry, 183, 384-397.Lewinsohn, P.M., Antonuccio, D.O., Steinmetz J.L. & Teri, L (1984) Thecoping with depression course. A psychoeducational intervention for unipolar depression. Castalia Publishing Company, Eugene, OR.

Christine Kuehner, PhDCentral Institute of Mental HealthPO Box 12212068072 Mannheim, GermanyTel: ++49-621-1703-731Fax: ++49-621-1703-741
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Conflict of interest: None Declared

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