Reem Alyoubi, Majed M Al-Hayani, Ahlam Mazi, Alkhansaa O Bajawi, Anas S Alyazidi, Summayah A Kobeisy
Identification of Child Abuse and Neglect Based on the Perception of Training Physicians in Jeddah, Saudi Arabia
Cureus
depression common young people marked negative impact associated selfharm suicide preventing onset would important advance public health update cochrane review last updated 2011to determine whether evidencebased psychological interventions including cognitive behavioural therapy cbt interpersonal therapy ipt third wave cbt effective preventing onset depressive disorder children adolescentswe searched specialised register cochrane common mental disorders group ccmdctr 11 september 2015 includes relevant randomised controlled trials following bibliographic databases cochrane library years embase 1974 date medline 1950 date psycinfo 1967 date searched conference abstracts reference lists included trials reviews contacted experts fieldwe included randomised controlled trials evidencebased psychological prevention programme compared comparison control young people aged 5 19 years currently meet diagnostic criteria depressiontwo authors independently assessed trials inclusion rated risk bias adjusted sample sizes take account cluster designs multiple comparisons contacted trial authors additional information needed assessed quality evidence primary outcomes using gradewe included 83 trials review majority trials 67 carried school settings eight colleges universities four clinical settings three community four mixed settings twentynine trials carried unselected populations 53 targeted populationsfor primary outcome depression diagnosis mediumterm followup 12 months 32 trials 5965 participants risk diagnosis depression reduced participants receiving intervention compared receiving intervention risk difference rd 003 95 confidence interval ci 005 001 p value 001 rated evidence moderate quality according grade criteria 70 trials 73 trial arms 13829 participants contributed analysis primary outcome depression symptoms selfrated postintervention time point results showing small statistically significant effect standardised mean difference smd 021 95 ci 027 015 p value 00001 effect persisted shortterm assessment point three months smd 031 95 ci 045 017 p value 00001 16 studies 1558 participants mediumterm 4 12 months assessment point smd 012 95 ci 018 005 p value 00002 53 studies 11913 participants however effect longer evident longterm followup rated evidence low moderate quality according grade criteriathe evidence review unclear regard whether type population modified overall effects statistically significant moderation overall effect depression symptoms p value 00002 depressive disorder p value 008 trials implemented universal populations effect depression diagnosis rd 001 95 ci 003 001 small effect depression symptoms smd 011 95 ci 017 005 trials implemented targeted populations statistically significantly beneficial effect intervention depression diagnosis rd 004 95 ci 007 001 depression symptoms smd 032 95 ci 042 023 note lack attention placebocontrolled trials targeted populations none depression diagnosis four depression symptoms among trials implemented universal populations number used attention placebo comparison intervention consistently showed effectoverall results show small positive benefits depression prevention primary outcomes selfrated depressive symptoms postintervention depression diagnosis 12 months beyond estimates numbers needed treat benefit nntb 11 compare well public health interventions however evidence moderate low quality using grade framework results heterogeneous prevention programmes delivered universal populations showed sobering lack effect compared attention placebo control interventions delivered targeted populations particularly selected basis depression symptoms larger effect sizes seldom used attention placebo comparison practical difficulties inherent implementation targeted programmes conclude still enough evidence support implementation depression prevention programmesfuture research focus current gaps knowledge given relative lack evidence universal interventions compared attention placebo controls poor results wellconducted effectiveness trials universal interventions opinion future trials test depression prevention programme indicated targeted population using credible attention placebo comparison group depressive disorder primary outcome measured longer term well clinicianrated depression trial consider scalability well potential intervention harm