Psychological interventions to prevent the onset of depressive disorders: a meta-analysis of randomized controlled trials

Cuijpers, Pim; Pineda, Blanca S.; Quero, Soledad; Karyotaki, Eirini; Struijs, Sascha Y.; Figueroa, Caroline A.; Llamas, Jazmin A.; Furukawa, Toshi A.; Muñoz, Ricardo F.

doi:10.1016/j.cpr.2020.101955

Cited by 149Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and AccessDigital Mental Health Interventions

Psychological interventions to prevent the onset of depressive disorders: a meta-analysis of randomized controlled trials

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Cuijpers, Pim, Pineda, Blanca S., Quero, Soledad, Karyotaki, Eirini, Struijs, Sascha Y., Figueroa, Caroline A., Llamas, Jazmin A., Furukawa, Toshi A. +1 more·2021·Clinical Psychology Review

DOI 10.1016/j.cpr.2020.101955

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Abstract

PURPOSE: Depressive disorders are common and have a considerable impact on patients and societies. Several treatments are available, but their effects are modest and reduce the burden only to a limited extent. Preventing the onset of depressive disorders may be one option to further reduce the global disease burden. METHODS: We conducted a meta-analysis of randomized controlled trials in participants without a diagnosis of depression at baseline, who were assigned to a preventive psychological intervention, or a care-as-usual, or comparable control group and in which incident cases of depression at follow-up were ascertained with a diagnostic interview. RESULTS: Our systematic searches resulted in 50 trials (14,665 participants) with relatively high quality, in high risk groups of all ages. The psychological interventions were mostly based on cognitive behavioral interventions. One year after the preventive interventions, the relative risk of developing a depressive disorder was RR = 0.81 (95% CI: 0.72-0.91), indicating that those who had received the intervention had 19% less chance to develop a depressive disorder. Given the average control event rate of 30%, twenty-one people had to participate in the intervention to prevent one depressive disorder compared to people in the control conditions. CONCLUSIONS: Prevention is a promising approach to reduce the global disease burden of depression in addition to treatments.

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Indicated prevention approaches have shown potential to reduce subclinical symptoms or prevent onset of a mental disorder in help-seeking and community samples.
“Indicated prevention approaches have shown the potential to reduce subclinical symptoms or even prevent the onset of a mental disorder in help-seeking and community samples [28–31]”
From Efficacy of a transdiagnostic Internet prevention approach in adolescents (EMPATIA study): study protocol of a randomized controlled trial (2024) · cites this paper as [28]
Psychological interventions for the prevention of major depression effectively reduce depression symptoms and avoid or at least delay major depression onset in people with known risk factors or subthreshold symptoms.
“Psychological interventions for the prevention of MDD have been shown to effectively reduce depression symptoms (Cuijpers et al., 2014) and avoid or at least delay MDD onset (Cuijpers et al., 2021; van Zoonen et al., 2014) in people with known risk factors (selective prevention) or with subthreshold symptoms (indicated prevention).”
From How to promote usage of telehealth interventions for farmers' mental health? A qualitative study on supporting and hindering aspects for acceptance and satisfaction with a personalized telephone coaching for depression prevention (2023) · cites this paper as Cuijpers et al., 2021
There are conflicting results on changes in help seeking recommendations and intentions from universal school-based programs.
“Once more, however, there are conflicting results on changes in help seeking recommendations and intentions. 376,381,382”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [381]

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Furukawa, T. A., Tajika, A., Sakata, M., Luo, Y., Toyomoto, R., Horikoshi, M., Akechi, T., Kawakami, N., Nakayama, T., Kondo, N., et al. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-067850 · Cited by 18 · see citing works
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Efficacy of psychological interventions for dysmenorrhea: a meta-analysis
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Effects of Vitamin D3 and Marine Omega-3 Fatty Acids Supplementation on Indicated and Selective Prevention of Depression in Older Adults
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Psychometric evaluation of the Arabic version of the Eight-item Center for Epidemiological Studies Depression Scale (CESD-8): Specific cultural considerations for the assessment of depression
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Depression
Malhi, G. S., Bell, E., Stavdal, A., Wu, C., Naylor, A., & Kumari, V. (2026) · The Lancet · doi:10.1016/s0140-6736(26)00201-1 · Cited by 16 · see citing works
Ameliorative effect of Gastrodia elata Blume extracts on depression in zebrafish and cellular models through modulating reticulon 4 receptors and apoptosis
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Prognostic factors and effect modifiers for personalisation of internet-based cognitive behavioural therapy among university students with subthreshold depression: A secondary analysis of a factorial trial
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Self-citation
Predicting future depressive episodes from resting-state fMRI with generative embedding
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Implementing a Digital Depression Prevention Program in Australian Secondary Schools: Cross-Sectional Qualitative Study
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Selective Prevention of Depression in Workers Using a Smartphone App: Randomized Controlled Trial
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Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators
Harrer, M., Sprenger, A. A., Illing, S., Adriaanse, M. C., Albert, S. M., Allart, E., Almeida, O. P., Basanovic, J., van Bastelaar, K. M. P., Batterham, P. J., et al. (2025) · The British Journal of Psychiatry · doi:10.1192/bjp.2025.56 · Cited by 15 · see citing works
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The COVID-19 Pandemic and Mental Health—Implementing Evidence-Based Interventions to Advance Equity and Reverse a Worsening Crisis
Muñoz, R. F., & Cooper, L. A. (2022) · JAMA Health Forum · doi:10.1001/jamahealthforum.2022.1282 · Cited by 13 · see citing works
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The association among negative life events, alexithymia, and depressive symptoms in a psychosomatic outpatient sample
Xie, Y., Ma, D., Duan, Y., Cao, J., & Wei, J. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05902-0 · Cited by 15 · see citing works
Policy implications of the 2020–22 Australian study of mental health and wellbeing
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Effectiveness of an Internet-Based Machine-Guided Stress Management Program Based on Cognitive Behavioral Therapy for Improving Depression Among Workers: Protocol for a Randomized Controlled Trial
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Psychological distress in adolescence and later economic and health outcomes in the United States population: A retrospective and modeling study
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How to promote usage of telehealth interventions for farmers' mental health? A qualitative study on supporting and hindering aspects for acceptance and satisfaction with a personalized telephone coaching for depression prevention
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“…for the prevention of MDD have been shown to effectively reduce depression symptoms (Cuijpers et al., 2014) and avoid or at least delay MDD onset (Cuijpers et al., 2021; van Zoonen et al., 2014) in people with known risk factors (selective prevention) or with subthreshold symptoms (indicated…”
Background
Why we need to pursue both universal and targeted prevention to reduce the incidence of affective and psychotic disorders: Systematic review and meta-analysis
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Digital prevention of depression for farmers? A qualitative study on participants' experiences regarding determinants of acceptance and satisfaction with a tailored guided internet intervention program
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Co-creating mental health promotion and prevention interventions with groups in vulnerable situations in Europe: a mixed-methods study protocol for co-creation implementation and participatory evaluation
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Preventing the onset of depressive disorders in low-and middle-income countries: An overview
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The Barancik lecture: Comorbidity in multiple sclerosis—Looking backward, looking forward
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Telephone coaching for the prevention of depression in farmers: Results from a pragmatic randomized controlled trial
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Top-funded companies offering digital health interventions for the prevention and treatment of depression: a systematic market analysis
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Pragmatic Indicated Prevention and Early Intervention for Disordered Eating: A Randomized Controlled Trial of Media Smart Targeted Internet Program in Youth
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Efficacy of non-pharmacological interventions for the prevention of antenatal depression: A systematic review and network meta-analysis
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The ‘discontinuity hypothesis’ of depression in later life—clinical and research implications
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A multiple health behaviour change intervention to prevent depression: A randomized controlled trial
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The language, framework, system enablers, and political commitment that a country needs to promote and protect the mental health of its citizens
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Preventing depression in high-income countries—A systematic review of studies evaluating change in social determinants
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A personalized intervention to prevent depression in primary care based on risk predictive algorithms and decision support systems: protocol of the e-predictD study
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Does outcome expectancy predict outcomes in online depression prevention? Secondary analysis of randomised‐controlled trials
Thielecke, J., Kuper, P. R., Ebert, D. D., Cuijpers, P. J., Smit, F., Riper, H. M., Lehr, D., & Buntrock, C. (2023) · Health Expectations · doi:10.1111/hex.13951 · Cited by 6 · see citing works
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Facilitating Thought Progression to Reduce Depressive Symptoms: Randomized Controlled Trial
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Development of a digital program for training non-specialist providers to deliver a psychosocial intervention for depression: a formative study to support scaling up task-shared depression care in the United States
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Long-Term Effects of Internet-Based Cognitive Behavioral Therapy on Depression Prevention Among University Students: Randomized Controlled Factorial Trial
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Developing and designing an internet-based support and education program for patients awaiting kidney transplantation with deceased donors through: a Delphi study
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Preventing the onset of mental disorders: An emerging field
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Promotion of mental health and prevention of mental disorders in a rich welfare state: A Norwegian perspective
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Closing the gap between screening and depression prevention: a qualitative study on barriers and facilitators from the perspective of public health professionals in a school-based prevention approach
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Efficacy of traditional Thai massage as adjunctive therapy in patients with major depressive disorder
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No prediction without prevention: A global qualitative study of attitudes toward using a prediction tool for risk of developing depression during adolescence
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Who benefits from indirect prevention and treatment of depression using an online intervention for insomnia? Results from an individual-participant data meta-analysis
Thielecke, J., Kuper, P. R., Lehr, D., Schuurmans, L., Harrer, M., Ebert, D. D., Cuijpers, P. J., Behrendt, D., Brückner, H., Horvath, H., et al. (2024) · Psychological Medicine · doi:10.1017/s0033291724000527 · Cited by 4 · see citing works
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Walking the Black Dog: A systematic review and meta-analysis on the effect of walking interventions on depressive symptom severity
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Enhancing prediction of major depressive disorder onset in adolescents: A machine learning approach
LoParo, D., Matos, A. P., Arnarson, E. Ö., & Craighead, W. E. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.01.007 · Cited by 4 · see citing works
Prevention of mental disorders after exposure to natural hazards: a meta-analysis
Kip, A., Weigand, L., Valencia, S., Deady, M., Cuijpers, P. J., & Sander, L. (2025) · BMJ Mental Health · doi:10.1136/bmjment-2024-301357 · Cited by 4 · see citing works
Self-citation
Participatory development and proof-of-concept of a dyadic-based, AI-driven, just-in-time adaptive intervention mechanism for preventing anxiety and depressive disorders via app: study protocol for a feasibility study
Zarski, A., Sextl-Plötz, T., Schmidt-Hantke, J., Hess, N. S., & Buntrock, C. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1626428 · Cited by 4 · see citing works
Does Telephone Coaching Improve Farmers' Mental Health in the Long Term? Results of the 12- and 18-month Follow-Up of a Pragmatic Randomized Controlled Trial
Thielecke, J., Titzler, I., Braun, L., Ebert, D. D., Freund, J., Baumeister, H., Berking, M., & Buntrock, C. (2025) · Occupational Health Science · doi:10.1007/s41542-024-00216-9 · Cited by 3 · see citing works
Internet-based indicated prevention of anxiety and depression disorder onset three-arm randomized clinical trial
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Development and evaluation of a psychological adjustment communication system for adolescents with polycystic ovary syndrome at a high risk of depression: A mixed-method study protocol
Tan, H., Gao, L., Guo, Y., Liu, Y., Ding, R., Yan, X., Wang, X., Wang, Y., & Wang, L. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.937280 · Cited by 3 · see citing works
What is the place of universal, selective, and indicated prevention strategies for depression and other mood disorders?
Hickie, I. B., Cuijpers, P. J., Scott, E. M., Skinner, A., & Iorfino, F. (2023) · Research Directions Depression · doi:10.1017/dep.2023.29 · Cited by 3 · see citing works
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How to distinguish promotion, prevention and treatment trials in public mental health? Study protocol for the development of the VErona-LUgano Tool (VELUT)
Purgato, M., Albanese, E., Papola, D., Prina, E., Tedeschi, F., Gross, A. L., Sijbrandij, M., Acartürk, C., Annoni, A. M., Silva, M., et al. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-082652 · Cited by 3 · see citing works
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Efficacy of a transdiagnostic Internet prevention approach in adolescents (EMPATIA study): study protocol of a randomized controlled trial
Hirsig, A., Häfeli, X. A., & Schmidt, S. J. (2024) · Trials · doi:10.1186/s13063-024-08241-3 · Cited by 2 · see citing works
“…have shown the potential to reduce subclinical symptoms or even prevent the onset of a mental disorder in help-seeking and community samples [28–31] with a relatively good benefit–cost ratio and with high participant satisfaction by allocating resources to those reporting a need for it [26,…”
Background
The effect of Ocimum basilicum on the prevention of postpartum depression symptoms and sleep quality: A triple-blind randomized controlled clinical trial
Abdi, M., Rezaei, E., Mirghafourvand‬‬‬‬‬‬‬‬‬‬‬‬‬‬, M., Ebrahimi, F., Payahoo, L., Shafiee‐Kandjani, A. R., & Ghanbari‐Homayi, S. (2025) · Heliyon · doi:10.1016/j.heliyon.2025.e42096 · Cited by 2 · see citing works
Self-Compassion as a Mediator of the Longitudinal Link Between Parent and Adolescent Depressive Symptoms
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Core depression symptoms, social support buffers, and diagnostic differences in Chinese university freshmen in Shenzhen: a network analysis
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Role of multiple risk factors in mental disorders diagnosed in middle-aged women: A population-based follow-up study
Wang, X., Memon, A. A., Palmér, K., Hedelius, A., Sundquist, J., & Sundquist, K. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.10.040 · Cited by 2 · see citing works
Transcranial Direct Current Stimulation (tDCS) and Online Wellbeing Training Used at Home for Perinatal and Maternal Loss Patients with a Diagnosis of Depression: Depression, Real World-Functioning, and Quality of Life Outcomes
Griffiths, C., da Silva, K. M., Mobee-Dumi, A., Gill, A. K., & Ibrahim, D. (2025) · Open Journal of Depression · doi:10.4236/ojd.2025.142003 · Cited by 2 · see citing works
Trajectories of Rumination and Negative Cognitive Style From Late Childhood Through Adolescence: Modeling Normative Growth Patterns and Predicting Cognitive Vulnerabilities
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Efficacy of Applied Relaxation as indicated preventive intervention in individuals at increased risk for mental disorders: A randomized controlled trial
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RESiLIENT (Resilience Enhancement with Smartphone in LIving ENvironmenTs) Trial: The Statistical Analysis PlanPreprint
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Conceptualization of a decision-analytic model in youth mental health: an application of stakeholder engagement in model development in the Netherlands
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The Efficacy of Interpersonal Psychotherapy
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Depressive and Anxiety Disorders
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Preventing the onset of major depressive disorder: A meta-analytic review of psychological interventions
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Preventing the Onset of Depressive Disorders: A Meta-Analytic Review of Psychological Interventions
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Reviews and Overviews Preventing the Onset of Depressive Disorders: A Meta- Analytic Review of Psychological Interventions
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Psychological interventions to prevent the onset of major depression in adults: a systematic review and individual participant data meta-analysis
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Has time come for broad‐scale dissemination for prevention of depressive disorders?
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Self-citation

Authors: Cuijpers, P., Pineda, B. S., Quero, S., Karyotaki, E., Struijs, S. Y., Figueroa, C. A., Llamas, J. A., Furukawa, T. A., & Muñoz, R. F.
Affiliations: Amsterdam Public Health (NL)
Palo Alto University (US)
Universitat Jaume I (ES)
Harvard University (US)
Leiden University (NL)
University of California, Berkeley (US)
Kyoto University (JP)
Corresponding author: Cuijpers, Pim
ORCID: Cuijpers, Pim
Pineda, Blanca S.
Quero, Soledad
Karyotaki, Eirini
Struijs, Sascha Y.
Figueroa, Caroline A.
Furukawa, Toshi A.
Muñoz, Ricardo F.
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2021-02
Volume: 83
Pages: 101955
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/j.cpr.2020.101955
OpenAlex: W3109375959
Semantic Scholar: 4892811095f93e382f3757230a5dfd7326e0d85c
Cited by: 148
References: 38
Citations by year: 2026: 20 · 2025: 24 · 2024: 30 · 2023: 44 · 2022: 19 · 2021: 11
FWCI: 2.70
Type: journal article
Language: en
Update notices: erratum (2021-08-01)
Open access: hybrid
doi.org
Licence: cc-by
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
creativecommons.org/licenses/by/4.0/ (vor)
Locations: Clinical Psychology Review (publishedVersion, cc-by)
PubMed (publishedVersion)
Pure Amsterdam UMC (publishedVersion, cc-by)
Repositori UJI (Universitat Jaume I) (publishedVersion, cc-by-sa)
VU Research Portal (publishedVersion, other-oa)
LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-sa)
Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders: Instituto de Salud Carlos III (ISC III CB06 03/0052)
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (ISC III CB06 03/0052)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords: depression prevention, depressive disorders, cognitive-behavioral intervention, incident depression, relative risk, disease burden
MeSH terms: Psychosocial Intervention, Depressive Disorder, Humans, Psychotherapy, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic

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Psychological interventions to prevent the onset of depressive disorders: a meta-analysis of randomized controlled trials

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