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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