Communication of individual risk factors to patients shows small potential for preventing major depression
Adult primary care patients in Spain received usual care or an intervention in which the primary care clinician communicated individual risk for depression, then constructed a tailored bio-psycho-family-social intervention and provided a booklet with strategies for avoiding depression.
Personalized primary care-delivered assessment and discussion of risk may hold some promise for preventing major depression in adults, a study found.
Researchers sought to evaluate the effectiveness of a depression prevention intervention in adult patients from 10 primary care centers in 7 cities in Spain. They received either usual care or an intervention in which the primary care clinician communicated individual risk for depression based on characteristics such as marital status, living situation, occupation, and health history and then constructed a tailored bio-psycho-family-social intervention and provided a booklet with strategies for avoiding depression.
The study was published online March 29 by Annals of Internal Medicine.
A cohort of 3,326 patients consented to the study, and at 18 months 7.39% of patients in the intervention group (95% CI, 5.85% to 8.95%) developed major depression compared with 9.40% in the control (usual care) group (95% CI, 7.89% to 10.92%; absolute difference, −2.01 percentage points [95% CI, −4.18 to 0.16 percentage points]; P=0.070). Depression incidence was lower in the intervention centers in 5 cities and similar between intervention and control centers in 2 cities.
The researchers noted that despite that lack of statistically significant difference in the primary outcome, the reduction in the intervention group seemed to increase over time, which might be due to a dose-response effect of the intervention or simply a need for time and the accumulation of intervention visits to create the changes needed to prevent depression. The intervention resulted in a statistically significant reduction in the incidence of anxiety at 18 months. A sensitivity analysis that included baseline depression plus additional covariates estimated an absolute improvement with the intervention of −2.17 percentage points, and the confidence interval indicated that the improvement was unlikely to have occurred by chance alone.
“On the basis of these combined results, we conclude that our intervention may not yet be ready for widespread use in clinical practice, but it deserves further study,” the authors wrote.