Background

Psychological interventions are increasingly discussed as a method to prevent major depressive disorder (MDD) in adults who already experience subthreshold depressive symptoms. In this individual participant data meta-analysis, we quantify the effect of preventive interventions against control on MDD onset in this population, and explore effect modifiers.

Methods

In this systematic review and individual participant data meta-analysis, we screened full-texts of eligible studies within the Metapsy research domain for articles on psychological interventions for depression, from database inception to May 1, 2023, published in English, German, Spanish, and Dutch. We included individual participant data of randomised trials comparing psychological interventions with a control group regarding their effects on MDD onset in adults with subthreshold depressive symptoms but no MDD at baseline, confirmed by standardised diagnostic interviews. Risk of bias was assessed using the RoB 2 tool. Effect on the onset of MDD (the primary outcome) and moderators were analysed using one-stage individual participant data meta-analysis. Survival analyses were conducted to examine effects on time to MDD onset within 12 months. We involved people with related lived experience in the study design and implementation. This study is registered with PROSPERO, CRD42017058585.

Findings

30 of 42 eligible randomised controlled trials with 7201 participants (2227 [30·9%] male, 4957 [68·9%] female, and 17 [0·2%] preferred not to report their sex) were included in our analysis (3697 participants had intervention and 3504 participants had control). The mean age of participants was 49·9 years (SD 19·2). Of the 3152 participants with reported ethnicity, 1608 (51·0%) were White. Five studies received a high risk of bias rating. Psychological interventions were associated with significantly reduced MDD incidence at post-treatment (incidence rate ratio [IRR] 0·57 [95% CI 0·35–0·93]; τ²=0·29; 18 studies), within 6 months (0·58 [0·39–0·88]; τ²=0·11; 18 studies), and within 12 months (0·67 [0·51–0·88]; τ²=0·05; 19 studies). No significant effect was observed at 24 months (IRR 1·16 [95% CI 0·66–2·03]; τ²=0·10; six studies). Preventive effects were stronger for individuals who had not previously had psychotherapy (IRR 0·39 [95% CI 0·25–0·62]) compared with those who had received psychotherapy before (0·92 [0·61–1·36]; p=0·029; seven studies). Although no overall linear association was identified, higher baseline depressive (Patient Health Questionnaire-9) and anxiety symptom (Generalized Anxiety Disorder-7) scores were associated with greater reductions in MDD onset risk. On the study level, delivery type appeared to moderate outcomes, with conference telephone calls being more effective than delivery via face-to-face, internet-based, and other formats (p=0·002), albeit based on only two studies of conference telephone calls with four comparisons. Other factors (eg, age) showed no significant differential effects.

Interpretation

Our findings show the effectiveness of preventive psychological interventions for subthreshold depressive symptoms. Tailoring interventions to consider participant-level and study-level factors could help to increase the impact of such interventions on a population level.

Funding

None.

中文翻译：

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预防成人重度抑郁症发作的心理干预：系统评价和个体参与者数据荟萃分析

 背景

心理干预越来越多地被讨论为预防已经出现阈下抑郁症状的成年人患重度抑郁症 （MDD） 的一种方法。在这项个体参与者数据荟萃分析中，我们量化了预防性干预措施对控制对该人群 MDD 发病的影响，并探讨了效果调节因素。

 方法

在本系统综述和个体参与者数据荟萃分析中，我们筛选了 Metapsy 研究领域内符合条件的研究的全文，以查找从数据库建库到 2023 年 5 月 1 日以英语、德语、西班牙语和荷兰语发表的抑郁症心理干预文章。我们纳入了随机试验的个体受试者数据，这些试验比较了心理干预与对照组对基线时有阈下抑郁症状但没有MDD的成年人MDD发作的影响，并通过标准化诊断访谈证实。使用 RoB 2 工具评估偏倚风险。使用一阶段个体参与者数据荟萃分析对 MDD 发作 （主要结局） 和调节因素的影响。进行生存分析以检查对 12 个月内 MDD 发作时间的影响。我们让具有相关生活经验的人参与研究设计和实施。这项研究已在 CRD42017058585 PROSPERO 注册。

 发现

我们的分析纳入了 42 项符合条件的随机对照试验中的 30 项，涉及 7201 名参与者（2227 名 [30·9%] 男性，4957 名 [68·9%] 女性和 17 名 [0·2%] 不愿报告其性别）（3697 名参与者接受干预，3504 名参与者接受对照组）。参与者的平均年龄为 49·9 岁 （SD 19·2）。在报告种族的 3152 名参与者中，1608 名 （51·0%） 是白人。5项研究获得高偏倚风险评级。心理干预与治疗后 MDD 发生率显著降低相关 （发生率比 [IRR] 0·57 [95% CI 0·35–0·93];τ ² =0·29;18 项研究）、6 个月内 （0·58 [0·39–0·88];τ ² =0·11;18 项研究） 和 12 个月内 （0·67 [0·51–0·88];τ ² =0·05;19 项研究）。24 个月时未观察到显著影响 （IRR 1·16 [95% CI 0·66–2·03];τ ² =0·10;六项研究）。与之前接受过心理治疗的个体 （0·92 [0·61–1·36];p=0·029;七项研究） 相比，既往未接受过心理治疗的个体 （IRR 0·39 [95% CI 0·25–0·62]）的预防效果更强。虽然没有发现总体线性关联，但较高的基线抑郁 （患者健康问卷 9） 和焦虑症状 （广泛性焦虑症 7） 评分与 MDD 发病风险的更大降低相关。在研究层面，电话会议的传递类型似乎对结局有节制，电话会议比通过面对面、基于互联网和其他形式进行的传递更有效 （p=0·002），尽管仅基于两项电话会议研究和四项比较。其他因素 （例如，年龄） 显示没有显着的差异效应。

 解释

我们的研究结果表明，预防性心理干预对阈下抑郁症状的有效性。调整干预措施以考虑受试者水平和研究水平的因素可能有助于增加此类干预措施对人群水平的影响。

 资金

 没有。