title: Intervention to Prevent Major Depression in Primary Care: A Cluster Randomized Trial.
abstract: BACKGROUND
  Not enough is known about universal prevention of depression in adults.
  
  
  OBJECTIVE
  To evaluate the effectiveness of an intervention to prevent major depression.
  
  
  METHODS
  Multicenter, cluster randomized trial with sites randomly assigned to usual care or an intervention. (ClinicalTrials.gov: NCT01151982).
  
  
  METHODS
  10 primary care centers in each of 7 cities in Spain.
  
  
  METHODS
  Two primary care physicians (PCPs) and 5236 nondepressed adult patients were randomly sampled from each center; 3326 patients consented and were eligible to participate.
  
  
  METHODS
  For each patient, PCPs communicated individual risk for depression and personal predictors of risk and developed a psychosocial program tailored to prevent depression.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Potential self-selection bias due to nonconsenting patients.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Institute of Health Carlos III.
authors.forename: Juan Ángel
authors.initials: JÁ
authors.lastname: Bellón
authors.forename: Sonia
authors.initials: S
authors.lastname: Conejo-Cerón
authors.forename: Patricia
authors.initials: P
authors.lastname: Moreno-Peral
authors.forename: Michael
authors.initials: M
authors.lastname: King
authors.forename: Irwin
authors.initials: I
authors.lastname: Nazareth
authors.forename: Carlos
authors.initials: C
authors.lastname: Martín-Pérez
authors.forename: Carmen
authors.initials: C
authors.lastname: Fernández-Alonso
authors.forename: Antonina
authors.initials: A
authors.lastname: Rodríguez-Bayón
authors.forename: Anna
authors.initials: A
authors.lastname: Fernández
authors.forename: José María
authors.initials: JM
authors.lastname: Aiarzaguena
authors.forename: Carmen
authors.initials: C
authors.lastname: Montón-Franco
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Ibanez-Casas
authors.forename: Emiliano
authors.initials: E
authors.lastname: Rodríguez-Sánchez
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Ballesta-Rodríguez
authors.forename: Antoni
authors.initials: A
authors.lastname: Serrano-Blanco
authors.forename: María Cruz
authors.initials: MC
authors.lastname: Gómez
authors.forename: Pilar
authors.initials: P
authors.lastname: LaFuente
authors.forename: María Del Mar
authors.initials: Mdel M
authors.lastname: Muñoz-García
authors.forename: Pilar
authors.initials: P
authors.lastname: Mínguez-Gonzalo
authors.forename: Luz
authors.initials: L
authors.lastname: Araujo
authors.forename: Diego
authors.initials: D
authors.lastname: Palao
authors.forename: Paola
authors.initials: P
authors.lastname: Bully
authors.forename: Fernando
authors.initials: F
authors.lastname: Zubiaga
authors.forename: Desirée
authors.initials: D
authors.lastname: Navas-Campaña
authors.forename: Juan
authors.initials: J
authors.lastname: Mendive
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Aranda-Regules
authors.forename: Alberto
authors.initials: A
authors.lastname: Rodriguez-Morejón
authors.forename: Luis
authors.initials: L
authors.lastname: Salvador-Carulla
authors.forename: Juan
authors.initials: J
authors.lastname: de Dios Luna
mesh_terms: D003865:Major Depressive Disorder / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D018570:Risk Assessment / Q000379:methods; D013030:Spain / Q000453:epidemiology