Effekt av psykologiske tiltak for å forebygge depresjon i primærhelsetjenesten: Systematisk oversikt og metaanalsye

Effectiveness of Psychological and Educational Interventions to Prevent Depression in Primary Care: A Systematic Review and Meta-Analysis

Forfattere
Conejo-Ceron, S. Moreno-Peral, P. Rodriguez-Morejon, A. Motrico, E. Navas-Campana, D. Rigabert, A. Martin-Perez, C. Rodriguez-Bayon, A. Ballesta-Rodriguez, M. I. Luna, J. D. Garcia-Campayo, J. Roca, M. Bellon, J. A.
Årstall
2017
Tidsskrift
Volum
15
Sider
262-271
PURPOSE Although evidence exists for the efficacy of psychosocial interventions to prevent the onset of depression, little is known about its prevention in primary care. We aimed to evaluate the effectiveness of psychological and educational interventions to prevent depression in primary care. METHODS We conducted a systematic review and meta-analysis of relevant randomized controlled trials (RCTs) examining the effect of psychological and educational interventions to prevent depression in nondepressed primary care attendees. We searched MEDLINE, PsycINFO, Web of Science, OpenGrey Repository, Cochrane Central Register of Controlled Trials, and other sources up to May 2016. At least 2 reviewers independently evaluated the eligibility criteria, extracted data, and assessed the risk of bias. We calculated standardized mean differences (SMD) using random-effects models. RESULTS We selected 14 studies (7,365 patients) that met the inclusion criteria, 13 of which were valid to perform a meta-analysis. Most of the interventions had a cognitive-behavioral orientation, and in only 4 RCTs were the intervention clinicians primary care staff. The pooled SMD was -0.163 (95% CI, -0.256 to -0.070; P = .001). The risk of bias and the heterogeneity (I-2 = 20.6%) were low, and there was no evidence of publication bias. Meta-regression detected no association between SMD and follow-up times or SMD and risk of bias. Subgroup analysis suggested greater effectiveness when the RCTs used care as usual as the comparator compared with those using placebo. CONCLUSIONS Psychological and educational interventions to prevent depression had a modest though statistically significant preventive effect in primary care. Further RCTs using placebo or active comparators are needed.

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Tiltaksnivå

Forebyggende og helsefremmende tiltak

Tema

Psykiske vansker og lidelser

Følelsesmessige problemer

Depresjon og nedstemthet (inkl. både vansker og lidelse)

Tiltak

Psykologiske behandlingsmetoder

Psykoedukative tiltak (inkl. videobasert modellæring)

Organisering av tiltak

E-helsetiltak (spill, internett, telefon)

Aldersgruppe

Barn i skolealder (6-12 år)

Ungdom (13-18 år)

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