Prevention of depression

Depressive disorders are highly prevalent and are associated with a huge disease burden, a considerable loss in quality of life and enormous economic costs. Current treatments can reduce the disease burden with about one third. Prevention of depression is very important and may be helpful in the further reduction of the disease burden of depression. A considerable body of research in the past 15 years has shown that preventive interventions are likely to be effective and can reduce the incidence with about 22%. In this paper, we show that traditional epidemiological research can not identify the best target groups for prevention. However, relatively simple statistics, such as the exposure rate, the population attributable fraction, and the numbers-needed-to-be-treated can be used to select those high-risk groups which are as small as possible, but can account for most of the new cases. Psycho-educational cognitive behaviour therapy is the most used preventive intervention for depression and it has been implemented in many countries. Over the next few years, the internet will probably give rise to new opportunities for broad-scale implementation of preventive interventions, because access is very scalable, economically affordable and effective. Another important development is that of stepped-care interventions. It is expected that this type of intervention will be able to reduce the incidence of depression further.