Efficacy of universal and selective prevention on depression in children and adolescents. A systematic review

Efficacy of universal and selective prevention on depression in children and adolescents. A systematic review Objective: Unipolar depressive disorder often begins in childhood, making it essential to prevent the development of depressive disorders early on. The current review describes the evidence of selective, indicated, and universal prevention of depression in children and adolescents based on published, systematic reviews, and metaanalyses. Method: Scientific databases were electronically searched for prevention studies done between 1990 and 2012 with children and adolescents and written in German and English. Ten systematic reviews and metaanalyses were identified as eligible for review. These reviews in turn investigated a total of 121 controlled studies, 52 of which were universal, 46 selective, and 19 targeted prevention studies. Four studies combined selective and indicated prevention. Results: Evidence was found for selective, indicated, and universal prevention in comparison to untreated control groups for efficacy in reducing depressive symptoms in children and adolescents. This was still evident for the follow-up at 3 to 9 months. Evidence for efficacy of selective prevention was still evident at 12 months post-intervention. The effect sizes were mostly low. Compared with placebo the efficacy is considerably lower or no evidence was found. Conclusions: The results of the single reviews were quite heterogeneous. For further research there is an urgent need to identify the factors responsible for effective programs and to test these under real-world conditions.