Barrera Alinne Z, Torres Leandro D, Muñoz Ricardo F
University of California, San Francisco and San Francisco General Hospital, San Francisco, CA 94110, USA.
Int Rev Psychiatry. 2007 Dec;19(6):655-70. doi: 10.1080/09540260701797894.
Major depression is one of the most prevalent mental disorders and the number one cause of disability worldwide. Once a person experiences a major depressive episode (MDE), the likelihood of recurrence is very high. The prevention of first onset, as well as the protection against recurrence after recovery, are therefore essential goals for the mental health field. By the end of the 20th century, however, most depression research efforts had focused on either acute or prophylactic treatment. In this article, we review USA and international studies that have attempted to reduce incidence of MDE, either 1) to prevent onset in populations of children and adults (including women during the postpartum period) not currently meeting diagnostic criteria for depression, or 2) to prevent a new episode in individuals who have recovered after treatment through protective, but not prophylactic interventions. We identified twelve randomized controlled trials focused on preventing the onset of major depression (both MDE and postpartum depression (PPD)), five randomized controlled trials focusing on preventing relapse, and no randomized controlled trials focused exclusively on preventing recurrent episodes through protective interventions. The review is limited in scope given that depression prevention trials focused on infants, young children, and older adults were not included in the review. The research to date suggests that the prevention of major depression is a feasible goal for the 21st century. If depression prevention interventions become a standard part of mental health services, unnecessary suffering due to depression will be greatly reduced. This review concludes with suggestions for the future direction of depression prevention research.
重度抑郁症是最常见的精神障碍之一，也是全球致残的首要原因。一旦一个人经历了重度抑郁发作（MDE），复发的可能性就非常高。因此，预防首次发作以及防止康复后复发是心理健康领域的重要目标。然而，到20世纪末，大多数抑郁症研究工作都集中在急性治疗或预防性治疗上。在本文中，我们回顾了美国和国际上的研究，这些研究试图降低MDE的发病率，要么是1）在目前未达到抑郁症诊断标准的儿童和成人（包括产后妇女）群体中预防发病，要么是2）通过保护性而非预防性干预措施，防止已治疗康复的个体出现新的发作。我们确定了12项专注于预防重度抑郁症（包括MDE和产后抑郁症（PPD））发作的随机对照试验，5项专注于预防复发的随机对照试验，没有专门通过保护性干预措施预防复发发作的随机对照试验。鉴于本综述未纳入针对婴儿、幼儿和老年人的抑郁症预防试验，其范围有限。迄今为止的研究表明，预防重度抑郁症是21世纪一个可行的目标。如果抑郁症预防干预措施成为心理健康服务的标准组成部分，因抑郁症导致的不必要痛苦将大大减少。本综述最后对抑郁症预防研究的未来方向提出了建议。
