Intervention to prevent major depression in primary care: A cluster randomized trial

Juan Ángel Bellón*, Sonia Conejo-Cerón, Patricia Moreno-Peral, Michael King, Irwin Nazareth, Carlos Martín-Pérez, Carmen Fernández-Alonso, Antonina Rodríguez-Bayón, Anna Fernández, José María Aiarzaguena, Carmen Montón-Franco, Inmaculada Ibanez-Casas, Emiliano Rodríguez-Sánchez, María Isabel Ballesta-Rodríguez, Antoni Serrano-Blanco, María Cruz Gómez, Pilar LaFuente, María Del Mar Muñoz-García, Pilar Mínguez-Gonzalo, Luz AraujoDiego Palao, Paola Bully, Fernando Zubiaga, Desirée Navas-Campaña, Juan Mendive, Jose Manuel Aranda-Regules, Alberto Rodriguez-Morejón, Luis Salvador-Carulla, Jaun De Dios Luna

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

26 Citations (Scopus)


Background: Not enough is known about universal prevention of depression in adults. Objective: To evaluate the effectiveness of an intervention to prevent major depression. Design: Multicenter, cluster randomized trial with sites randomly assigned to usual care or an intervention. (ClinicalTrials .gov: NCT01151982) Setting: 10 primary care centers in each of 7 cities in Spain. Participants: Two primary care physicians (PCPs) and 5236 nondepressed adult patients were randomly sampled from each center; 3326 patients consented and were eligible to participate. Intervention: For each patient, PCPs communicated individual risk for depression and personal predictors of risk and developed a psychosocial program tailored to prevent depression. Measurements: New cases of major depression, assessed every 6 months for 18 months. Results: At 18 months, 7.39% of patients in the intervention group (95% CI, 5.85% to 8.95%) developed major depression compared with 9.40% in the control (usual care) group (CI, 7.89% to 10.92%) (absolute difference, -2.01 percentage points [CI, -4.18 to 0.16 percentage points]; P = 0.070). Depression incidence was lower in the intervention centers in 5 cities and similar between intervention and control centers in 2 cities. Limitation: Potential self-selection bias due to nonconsenting patients. Conclusion: Compared with usual care, an intervention based on personal predictors of risk for depression implemented by PCPs provided a modest but nonsignificant reduction in the incidence of major depression. Additional study of this approach may be warranted.

Original languageEnglish
Pages (from-to)656-665
Number of pages10
JournalAnnals of Internal Medicine
Issue number10
Publication statusPublished - 17 May 2016
Externally publishedYes


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