This work received support from KT Canada funding from the Canadian Institutes of Health
Research (CIHR)
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Psychological Depression
Prevention Programs for 5-19
Year Olds: What’s the
Evidence?
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A Model for Evidence-Informed
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Source: National Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence-Informed DecisionMaking in Public Health. [fact sheet]. Retrieved from http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf

Evidence-Informed Decision Making
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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
1. Population (situation)
2. Intervention (exposure)
3. Comparison (other group)
4. Outcomes
5. Setting
Think “PICOS”

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 postintervention, to 3 to 9 months, and 12 months post
intervention; The longer term impact is unclear.

Targeted vs. Universal
Interventions
Similar level of
effectiveness for BOTH
targeted and universal
interventions
Up to 9 months
post intervention
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 highrisk 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.

Questions?

Poll Questions # 2 and 3
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