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Components of cognitive-behavioral interventions to prevent the onset of depression among the high-risk population: a
Masatsugu Sakata1, Ethan Sahker2, Yan Luo3
1Department of Neurodevelopmental Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Health Promotion and Behavioral Sciences, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan; International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba Institute for Advanced Research (TIAR), University of Tsukuba, Tsukuba, Japan.
Objectives:
Cognitive Behavioral Therapy (CBT) is a promising strategy for preventing onset of depression. This systematic review and component network meta-analysis (cNMA) investigated efficacious and harmful components including various skills and delivery formats of CBT for preventing depression onset among at-risk populations.
Eligibility Criteria:
We selected randomized trials of preventive CBT interventions from a previous systematic review (Cuijpers et al., 2021), and conducted an additional search on PubMed and PsycINFO up to January 2022.
Methods Of Synthesis:
The primary outcome was incidence of diagnosed depression. Both intervention-level NMA and cNMA estimated the preventive effect of intervention arms and components.
Results:
We identified 44 prevention trials (N = 9519). The intervention-level NMA demonstrated the preventive effects of CBT over no intervention (OR=0.52, 95 %CI: 0.39 to 0.69). There was some evidence from cNMA showing that problem-solving and behavioral activation may be beneficial in preventing depression. These two components combined in the unguided self-help or the group format showed an odds ratio of 0.25 (95 %CI: 0.08 to 0.81 ) and 0.31 (95 %CI: 0.15 to 0.64), respectively. We developed a web application estimating the relative and absolute effects of various combinations of components (https://yan-luo.shinyapps.io/cNMA_depression/).
Conclusion:
Our results support the preventive effect of CBT on depression onset. In particular, efficacious depression prevention interventions can include problem-solving and behavioral activation.
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