Preventing the Onset of Depressive Disorders: State of the Art and Future Directions

The prevention of depressive disorders may be an important way to reduce the disease burden. All three types of prevention (universal, selective, and indicated) have potential but also have important limitations. Increasing evidence suggests that universal prevention, aimed at a population, may have no impact on the incidence of depression. Selective prevention, aimed at high-risk groups, is probably effective but may be mostly helpful for those who already have problems. Indicated prevention, aimed at people with depressive symptoms but no disorder, is also probably effective, but uptake is very low. Innovation in the field is very much needed, including well-powered and longitudinal trials aimed at important determinants, such as poor parenting, interparental conflict, and family instability, but also inequalities, social status, and migration.