Psychological depression prevention programs for 5-10 year olds: What’s the evidence?

Welcome! This work received support from KT Canada funding from the Canadian Institutes of Health

Research (CIHR)

Psychological Depression Prevention Programs for 5-19

Year Olds: What’s the Evidence?

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Source: National Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence-Informed Decision-Making in Public Health. [fact sheet]. Retrieved from http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf

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Review

Merry, S., Hetrick, S.E., Cox, G.R., Brudevold-Iversen, T., Bir, J.J., & McDowell, H. (2011). Psychological and/or educational interventions for the prevention of depression in children and adolescents. Cochrane Database of Systematic Reviews, 2011(12), Art. No.: CD003380.

Importance of this Review

• The World Health Organization estimates that depression represents the largest burden of disease to Canadians older than 14 years of age, as the years lost to premature death and disability from depression outnumber those lost to any other disease.

• High stress levels and feelings of depression are more common between the ages for 18 and 19 than in any other age group.

Poll Question #1

Who has heard of a PICO(S)

question before?

1.Yes

2.No

Searchable Questions Think “PICOS”

1. Population (situation)

2. Intervention (exposure)

3. Comparison (other group)

4. Outcomes

5. Setting

Evidence Summary: Edmonds (2013)

Objective: To determine whether psychological or

educational interventions, or both, are effective in preventing the onset of depressive disorder in children and adolescents.

P Children and adolescents ages 5 to 19 years old I Psychological or educational programs, or both,

which are either targeted or universal C Placebo, any comparison intervention, or no

intervention O Prevalence of depressive disorder and depressive

symptoms

Overall Considerations

• Quality Rating: 10 (strong) Methodologically strong review based on 68 randomized controlled trials of moderate quality.

• Psychological and educational interventions are effective at preventing depressive disorder and reducing depression symptoms in children and adolescents aged 5 to 19 years.

• Effectiveness is maintained from immediately post-intervention, to 3 to 9 months, and 12 months post intervention; The longer term impact is unclear.

Targeted vs. Universal Interventions

Up to 9 months post intervention

Similar level of effectiveness for BOTH targeted and universal

interventions

ONLY targeted interventions

At 12 months

No effect has been shown to persist beyond 24

months for both targeted and universal interventions.

What’s the evidence - Outcomes reported in the review

1. Diagnosis of depressive disorder (16 RCTs, 3240 subjects)

2. Depression scores (55 RCTS, 14, 406 subjects)

What’s the evidence – Diagnosis of depressive disorders

• Compared to no intervention, intervention participants showed a very small statistically significant reduced risk of depressive disorder :

Immediately post-intervention (15 studies; RD -0.09;

95% CI -0.14 to -0.05)

At 3 to 9 months (14 studies; RD -0.11; 95% CI -0.16 to -0.06)

At 12 months (10 studies; RD -0.06; 95% CI -0.11 to -0.01)

What’s the evidence – Diagnosis of depressive disorders

• At 3 to 9 months, risk reduction is maintained for:

Interventions targeting high-risk individuals (10 studies; RD -0.06; 95% CI -0.10, -0.03)

Universally applied interventions, regardless of risk

factors (9 studies; RD -0.10, 95% CI -0.33, -0.05) • At 12 months, only targeted interventions with high-

risk subjects had significantly reduced risk of depressive disorder (3 studies; RD -0.14; 95% CI -0.24, -0.04)

What’s the evidence – Diagnosis of depressive disorders

• There was no risk reduction at 24 months (8 studies), but a very small statistically significant risk reduction at 36 months (2 studies; RD -0.10; 95%CI -0.19 to -0.02)

What’s the evidence – Depression Scores

• Compared to no intervention, intervention

participants showed a small to very small statistically significant decrease in depression symptoms:

immediately post-intervention (50 studies; SMD -0.20;

95% CI -0.26 to -0.14) at 3 to 9 months (31 studies; SMD -0.16; 95% CI -0.23 to

-0.10) at 12 months (19 studies; SMD -0.10; 95% CI -0.18 to -

0.02)

What’s the evidence – Depression Scores

• No impact on depression symptoms at 24 months (12

studies) and 36 months (5 studies) • No impact on depression symptoms post-intervention

when the intervention is compared to a placebo (5 studies)

What’s the evidence – Depression Scores (Targeted vs. Universal)

• Interventions targeting high-risk individuals and those universally applied showed decrease in depression symptoms from immediately post-intervention to 9 months post intervention

• At 12 months, only targeted interventions showed a decrease in depression symptoms

• No decrease was seen at 24 months

General Implications

Public Health should provide psychological and educational interventions to prevent depression in children and adolescents up to 12 months post intervention. Public Health should not expect children and adolescents to experience positive effects more than 12 months after intervention. Public Health should consider how the effects of psychological and educational interventions can best be maintained.

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