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Übersichtsarbeit

Wirksamkeit universeller und selektiver Prävention von Depression im Kindes- und Jugendalter

Ein systematischer Review

Published Online:October 29, 2012https://doi.org/10.1024/1422-4917/a000198

Abstract

Fragestellung: Depressive Störungen beginnen häufig im Kindesalter, sodass bereits frühzeitig präventive Maßnahmen einsetzten sollten. Ziel der vorliegenden Arbeit ist es, auf der Basis bereits publizierter systematischer Reviews und Metaanalysen die Evidenz der selektiven, indizierten und universellen Prävention für das Kindes- und Jugendalter zusammenfassend darzustellen und Empfehlungen für die Praxis abzuleiten. Methodik: Zwischen 1990 und 2012 wurde in wissenschaftlichen Datenbanken nach deutsch und englischsprachigen Arbeiten zur Prävention von Depression im Kindes- und Jugendalter recherchiert. 10 systematische Reviews und Metaanalysen wurden eingeschlossen. Diese untersuchten insgesamt 121 ausschließlich kontrollierte Studien zu 52 universellen, 46 selektiven und 19 indizierten Präventionsprogrammen. Vier Studien kombinierten selektive und indizierte Prävention. Ergebnisse: Im Vergleich zu unbehandelten Kontrollgruppen gibt es sowohl für selektive und indizierte als auch universelle Prävention Evidenz für deren Wirksamkeit in der Reduktion depressiver Symptome. Dies gilt kurzfristig und bis zu einem Follow-up- Zeitraum von 9 Monaten. Selektive Ansätze zeigen Wirksamkeitsnachweise bis 12 Monate. Die Effektstärken sind meist niedrig. Wenn die Vergleiche mit Placebo- Kontrollgruppen durchgeführt werden, ist die Evidenz deutlich geringer oder nicht nachweisbar. Schlussfolgerungen: Die Ergebnisse der einzelnen Reviews sind sehr heterogen. Wichtig erscheint zukünftig zu klären, welche Faktoren für wirksame Prävention verantwortlich sind und wie die Präventionsprogramme erfolgreich in die Praxis integriert werden können.


Efficacy of universal and selective prevention on depression in children and adolescents. A systematic review

Objective: Unipolar depressive disorder often begins in childhood, making it essential to prevent the development of depressive disorders early on. The current review describes the evidence of selective, indicated, and universal prevention of depression in children and adolescents based on published, systematic reviews, and metaanalyses. Method: Scientific databases were electronically searched for prevention studies done between 1990 and 2012 with children and adolescents and written in German and English. Ten systematic reviews and metaanalyses were identified as eligible for review. These reviews in turn investigated a total of 121 controlled studies, 52 of which were universal, 46 selective, and 19 targeted prevention studies. Four studies combined selective and indicated prevention. Results: Evidence was found for selective, indicated, and universal prevention in comparison to untreated control groups for efficacy in reducing depressive symptoms in children and adolescents. This was still evident for the follow-up at 3 to 9 months. Evidence for efficacy of selective prevention was still evident at 12 months post-intervention. The effect sizes were mostly low. Compared with placebo the efficacy is considerably lower or no evidence was found. Conclusions: The results of the single reviews were quite heterogeneous. For further research there is an urgent need to identify the factors responsible for effective programs and to test these under real-world conditions.

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