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Prevention of depression with primary care patients: A randomized controlled trial

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American Journal of Community Psychology

Abstract

The prevention of major depression is an important research goal which deserves increased attention. Depressive symptoms and disorders are particularly common in primary care patients and have a negative impact on functioning and well-being comparable with other major chronic medical conditions. The San Francisco Depression Prevention Research project conducted a randomized, controlled, prevention trial to demonstrate the feasibility of implementing such research in a public sector setting serving low-income, predominantly minority individuals: 150 primary care patients free from depression or other major mental disorders were randomized to an experimental cognitive-behavioral intervention or to a control condition. The experimental intervention group reported a significantly greater reduction in depressive levels. Decline in depressive levels was significantly mediated by decline in the frequency of negative conditions. Group differences in the number of new episodes (incidence) of major depression did not reach significance during the 1-year trial. We conclude that depression prevention trials in public sector primary care settings are feasbile, and that depressive symptoms can be reduced even in low-income, minority populations. To conduct randomized prevention trials that can test effects on incidence with sufficient statistical power, subgroups at greater imminent risk have to be identified.

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Authors and Affiliations

  1. Department of Psychiatry, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, Suite 7M, 94110, San Francisco, California

    Ricardo F. Muñoz

Authors
  1. Ricardo F. Muñoz
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  2. Yu-Wen Ying
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  3. Guillermo Bernal
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  4. Eliseo J. Pérez-Stable
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  5. James L. Sorensen
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  6. William A. Hargreaves
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  7. Jeanne Miranda
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  8. Leonard S. Miller
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Additional information

This study was supported in part by a grant (MH37992) from the National Institute of Mental Health (Muñoz, P. I.). Xiulan Zhang, Florentius Chan, and Martha Shumway assisted with the analyses. Regina Armas coordinated administration of the Diagnostic Interview Schedule. Steve Batki, James Dilley, and Roberto Gurza conducted pilot studies for this project. Ana Isabel Alvarez was one of the Spaish language instructors for the current study. We gratefully acknowledge the cooperation of the patients and personnel of the San Francisco General Hospital General Medicine Clinic (Richard Fine, Director), Family Health Clinic (Robert Drickey and Joyce Bradey, former Directors), and The University of California General Medicine Practice (Albert Martin, former Director). Manuscript preparation was supported in part by a University of California SCR43 Program Development Grant for the University of California, San Francisco/San Francisco General Hospital latino Task Force's Latino Mental Health Research Program. We thank Sonia Gálvez for her assistance in this task. Muñoz, Sorensen, Hargreaves, and Miranda are in the Department of Psychiatry and Pérez-Stable in the Department of Medicine at the University of California, San Francisco. Ying and Miller are at the School of Social Welfare, University of California, Berkeley. Bernal is in the Department of Psychology, University of Puerto Rico.

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Muñoz, R.F., Ying, YW., Bernal, G. et al. Prevention of depression with primary care patients: A randomized controlled trial. Am J Commun Psychol 23, 199–222 (1995). https://doi.org/10.1007/BF02506936

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