The “Major Depressive Disorder” (MDD) is a clinically diagnosable and severe mental health condition, ranking among the most common worldwide. Its prevalence has risen over the past two decades. Despite various treatment options, such as psychotherapy or medication, their effectiveness in adults remains modest. Even under optimal care, the burden of MDD is only reduced by approximately one-third. Only a small fraction of those affected receive adequate care, highlighting the pressing need for effective preventive approaches to avoid MDD.
Against this backdrop, a new study was conducted under the leadership Prof. Dr. David Daniel Ebert, Head of the Assistant Professorship of Psychology and Digital Mental Health Care. The research team, including Jun.-Prof. Dr. Claudia Buntrock and Mathias Harrer, a research associate at the chair, investigated the effectiveness of psychological interventions in preventing MDD among adults with subclinical depressive symptoms. The study's findings were published in The Lancet Psychiatry under the title “Psychological interventions to prevent the onset of major depression in adults: a systematic review and individual participant data meta-analysis.” The journal has an impact factor of 30.8.
The primary research goal was to quantify the effect of preventive interventions for MDD and to identify moderators. According to the research team, the first aim was ultimately to provide evidence that depression can be prevented if timely action is taken. Secondly, they sought to determine how interventions could be tailored to individuals in a personalized way.
Prof. Dr. Ebert explains: "As a rule, individuals are only treated once their symptoms meet the clinical criteria for depression. However, there is now a shift in thinking. We have examined existing scientific studies on the subject to determine whether early interventions can prevent the development of a depressive disorder."
Mathias Harrer highlights what distinguishes this study: “This is an Individual Participant Data Meta-Analysis (IPDMA). The study's greatest strength lies in compiling data from 30 randomized controlled trials worldwide, sourced from the Metapsy database. This comprehensive approach allows us not only to draw robust conclusions about the efficacy of specific psychotherapeutic methods but also to determine what works better or worse for whom.”
The systematic review and meta-analysis, registered with PROSPERO (CRD42017058585), synthesized data from 30 randomized controlled trials involving 7,201 participants, primarily from high-income countries. The studies included adults with subclinical depressive symptoms but no prior MDD diagnosis. The analysis revealed a significant reduction in the incidence of depression by 42% within six months, which decreased to 33% over twelve months. These results exceed those of earlier meta-analyses, which reported reductions of only 19% and 22%. Psychological interventions during the first year were linked to decreased MDD incidence, reduced symptom severity, and fewer cases of symptom exacerbation.
Jun.-Prof. Dr. Buntrock interprets the findings: “The key takeaway is that preventive interventions for people with depressive symptoms can yield significant effects lasting up to a year. The evidence raises the question of whether psychological interventions might function like vaccines that require regular boosters. Furthermore, the results suggest that prevention measures are broadly effective across diverse populations, not just within specific subgroups.”
Harrer underscores the study's implications: “For the healthcare system, our message is clear: We need to shift focus in mental health from purely curative approaches to preventive strategies. Awareness must be raised about the efficacy of prevention. Concurrently, research is needed to ensure interventions are broadly accessible and sustainable, such as by incorporating booster strategies. It is also crucial to avoid over-pathologizing transient depressive symptoms. Further investigation is needed to determine when subclinical symptoms justify intervention without causing unnecessary concern for individuals.”
The findings emphasize the importance of prevention in reducing the global burden of MDD and highlight the need for future research into long-term efficacy and accessibility of these interventions.
Link to the Assistant Professorship of Psychology and Digital Mental Health Care
Contact:
Prof. Dr. David Daniel Ebert
Assistant Professorship of Psychology and Digital Mental Health Care
Georg-Brauchle-Ring 60/62
D-80992 München
E-Mail: david.daniel.ebert(at)tum.de
Mathias Harrer
Assistant Professorship of Psychology and Digital Mental Health Care
Georg-Brauchle-Ring 60/62
D-80992 München
E-Mail: mathias.harrer(at)tum.de
Text: Jasmin Schol
Photos: Pexels/Privat