Psychological and educational interventions for preventing depression in children and adolescents

Sally N Merry; Sarah E Hetrick; Georgina R Cox; Tessa Brudevold‐Iversen; Julliet J Bir; Heather McDowell

doi:10.1002/14651858.CD003380.pub3

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Figure 1

Risk of bias graph: Review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 2

Forest plot of comparison: Intervention versus no intervention, post‐intervention; outcome: 1.1 Depressive disorder

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Figure 3

Forest plot of comparison: 1 Intervention versus no intervention, three to nine months follow‐up; outcome: 3.1 Depressive disorder

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Figure 4

Forest plot of comparison: Intervention versus no intervention, 12 months follow‐up; outcome: 5.1 Depressive disorder (by population).

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Figure 5

Forest plot of comparison: Intervention versus no intervention, post‐intervention; outcome: 1.5 Depression scores.

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Figure 6

Forest plot of comparison: Intervention versus no intervention, three to nine months follow‐up; outcome: 3.5 Depression scores.

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Figure 7

Forest plot of comparison: Intervention versus no intervention, 12 months follow‐up; outcome: 5.5 Depression scores.

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Figure 8

Forest plot of comparison: Intervention versus placebo, post‐intervention; outcome: 2.5 Depression scores.

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Figure 9

Funnel plot of comparison: 1 Psychological/educational intervention versus no intervention/wait‐list/usual care, outcome: 1.1 Depressive disorder (by population).

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Figure 10

Funnel plot of comparison: 1 Psychological/educational intervention versus no intervention/wait‐list/usual care, outcome: 1.5 Depression scores (by population).

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Analysis 1.1

Comparison 1 Psychological/educational intervention versus no intervention/wait‐list/usual care, Outcome 1 Depressive disorder (by population).

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Analysis 1.2

Comparison 1 Psychological/educational intervention versus no intervention/wait‐list/usual care, Outcome 2 Depressive disorder (by intervention).

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Analysis 1.3

Comparison 1 Psychological/educational intervention versus no intervention/wait‐list/usual care, Outcome 3 Depressive disorder (by sex).

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Analysis 1.4

Comparison 1 Psychological/educational intervention versus no intervention/wait‐list/usual care, Outcome 4 Depressive disorders (by risk).

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Analysis 1.5

Comparison 1 Psychological/educational intervention versus no intervention/wait‐list/usual care, Outcome 5 Depression scores (by population).

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Analysis 1.6

Comparison 1 Psychological/educational intervention versus no intervention/wait‐list/usual care, Outcome 6 Depression scores (by intervention).

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Analysis 1.7

Comparison 1 Psychological/educational intervention versus no intervention/wait‐list/usual care, Outcome 7 Depression scores (by sex).

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Analysis 1.8

Comparison 1 Psychological/educational intervention versus no intervention/wait‐list/usual care, Outcome 8 Depression scores (by risk).

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Analysis 2.1

Comparison 2 Psychological/educational intervention versus placebo/attention/other intervention, Outcome 1 Depressive disorder (by population).

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Analysis 2.2

Comparison 2 Psychological/educational intervention versus placebo/attention/other intervention, Outcome 2 Depressive disorder (by intervention).

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Analysis 2.3

Comparison 2 Psychological/educational intervention versus placebo/attention/other intervention, Outcome 3 Depression scores (by population).

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Analysis 2.4

Comparison 2 Psychological/educational intervention versus placebo/attention/other intervention, Outcome 4 Depression scores (by intervention).

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Analysis 2.5

Comparison 2 Psychological/educational intervention versus placebo/attention/other intervention, Outcome 5 Depression scores (by gender).

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Analysis 3.1

Comparison 3 Psychological/educational intervention versus no intervention/wait‐list/usual care three to nine months, Outcome 1 Depressive disorder (by population).

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Analysis 3.2

Comparison 3 Psychological/educational intervention versus no intervention/wait‐list/usual care three to nine months, Outcome 2 Depressive disorder (by intervention).

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Analysis 3.3

Comparison 3 Psychological/educational intervention versus no intervention/wait‐list/usual care three to nine months, Outcome 3 Depressive disorder (by sex).

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Analysis 3.4

Comparison 3 Psychological/educational intervention versus no intervention/wait‐list/usual care three to nine months, Outcome 4 Depressive disorder (by risk).

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Analysis 3.5

Comparison 3 Psychological/educational intervention versus no intervention/wait‐list/usual care three to nine months, Outcome 5 Depression scores (by population).

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Analysis 3.6

Comparison 3 Psychological/educational intervention versus no intervention/wait‐list/usual care three to nine months, Outcome 6 Depression scores (by intervention).

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Analysis 3.7

Comparison 3 Psychological/educational intervention versus no intervention/wait‐list/usual care three to nine months, Outcome 7 Depression scores (by sex).

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Analysis 3.8

Comparison 3 Psychological/educational intervention versus no intervention/wait‐list/usual care three to nine months, Outcome 8 Depression scores (by risk).

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Analysis 4.1

Comparison 4 Psychological/educational intervention versus placebo/attention/other intervention three to nine months, Outcome 1 Depression scores (by population).

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Analysis 4.2

Comparison 4 Psychological/educational intervention versus placebo/attention/other intervention three to nine months, Outcome 2 Depression scores (by intervention).

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Analysis 5.1

Comparison 5 Psychological/educational intervention versus no intervention/wait‐list/usual care 12 months, Outcome 1 Depressive disorder (by population).

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Analysis 5.2

Comparison 5 Psychological/educational intervention versus no intervention/wait‐list/usual care 12 months, Outcome 2 Depressive disorder (by intervention).

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Analysis 5.3

Comparison 5 Psychological/educational intervention versus no intervention/wait‐list/usual care 12 months, Outcome 3 Depressive disorder (by sex).

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Analysis 5.4

Comparison 5 Psychological/educational intervention versus no intervention/wait‐list/usual care 12 months, Outcome 4 Depressive disorder (by risk).

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Analysis 5.5

Comparison 5 Psychological/educational intervention versus no intervention/wait‐list/usual care 12 months, Outcome 5 Depression scores (by population).

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Analysis 5.6

Comparison 5 Psychological/educational intervention versus no intervention/wait‐list/usual care 12 months, Outcome 6 Depression scores (by intervention).

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Analysis 5.7

Comparison 5 Psychological/educational intervention versus no intervention/wait‐list/usual care 12 months, Outcome 7 Depression scores (by sex).

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Analysis 5.8

Comparison 5 Psychological/educational intervention versus no intervention/wait‐list/usual care 12 months, Outcome 8 Depression scores (by risk).

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Analysis 6.1

Comparison 6 Psychological/educational intervention versus placebo/attention/other intervention 12 months, Outcome 1 Depression scores (by population).

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Analysis 6.2

Comparison 6 Psychological/educational intervention versus placebo/attention/other intervention 12 months, Outcome 2 Depression scores (by intervention).

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Analysis 6.3

Comparison 6 Psychological/educational intervention versus placebo/attention/other intervention 12 months, Outcome 3 Depression scores (by sex).

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Analysis 7.1

Comparison 7 Psychological/educational intervention versus no intervention/wait‐list/usual care 24 months, Outcome 1 Depressive disorder (by population).

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Analysis 7.2

Comparison 7 Psychological/educational intervention versus no intervention/wait‐list/usual care 24 months, Outcome 2 Depressive disorder (by intervention).

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Analysis 7.3

Comparison 7 Psychological/educational intervention versus no intervention/wait‐list/usual care 24 months, Outcome 3 Depressive disorder (by sex).

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Analysis 7.4

Comparison 7 Psychological/educational intervention versus no intervention/wait‐list/usual care 24 months, Outcome 4 Depressive disorder (by risk).

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Analysis 7.5

Comparison 7 Psychological/educational intervention versus no intervention/wait‐list/usual care 24 months, Outcome 5 Depression scores (by population).

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Analysis 7.6

Comparison 7 Psychological/educational intervention versus no intervention/wait‐list/usual care 24 months, Outcome 6 Depression scores (by intervention).

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Analysis 7.7

Comparison 7 Psychological/educational intervention versus no intervention/wait‐list/usual care 24 months, Outcome 7 Depression scores (by sex).

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Analysis 7.8

Comparison 7 Psychological/educational intervention versus no intervention/wait‐list/usual care 24 months, Outcome 8 Depression scores (by risk).

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Analysis 8.1

Comparison 8 Psychological/educational intervention versus placebo/attention/other intervention 24 months, Outcome 1 Depression scores (by population).

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Analysis 8.2

Comparison 8 Psychological/educational intervention versus placebo/attention/other intervention 24 months, Outcome 2 Depression scores (by intervention).

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Analysis 9.1

Comparison 9 Psychological/educational intervention versus no intervention/wait‐list/usual care 36 months, Outcome 1 Depressive disorder (by population).

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Analysis 9.2

Comparison 9 Psychological/educational intervention versus no intervention/wait‐list/usual care 36 months, Outcome 2 Depressive disorder (by intervention).

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Analysis 9.3

Comparison 9 Psychological/educational intervention versus no intervention/wait‐list/usual care 36 months, Outcome 3 Depression scores (by population).

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Analysis 9.4

Comparison 9 Psychological/educational intervention versus no intervention/wait‐list/usual care 36 months, Outcome 4 Depression scores (by intervention).

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Analysis 9.5

Comparison 9 Psychological/educational intervention versus no intervention/wait‐list/usual care 36 months, Outcome 5 Depression scores (by sex).

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Analysis 9.6

Comparison 9 Psychological/educational intervention versus no intervention/wait‐list/usual care 36 months, Outcome 6 Depression scores (by risk).

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Comparison 1. Psychological/educational intervention versus no intervention/wait‐list/usual care

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depressive disorder (by population) Show forest plot	18	3115	Risk Difference (M‐H, Random, 95% CI)	‐0.09 [‐0.14, ‐0.05]

1.1 Targeted	7	890	Risk Difference (M‐H, Random, 95% CI)	‐0.07 [‐0.12, ‐0.02]
1.2 Universal	11	2225	Risk Difference (M‐H, Random, 95% CI)	‐0.12 [‐0.20, ‐0.05]
2 Depressive disorder (by intervention) Show forest plot	18	3115	Risk Difference (M‐H, Random, 95% CI)	‐0.09 [‐0.14, ‐0.05]

2.1 Educational	0	0	Risk Difference (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
2.2 Psychological	18	3115	Risk Difference (M‐H, Random, 95% CI)	‐0.09 [‐0.14, ‐0.05]
3 Depressive disorder (by sex) Show forest plot	13	3669	Risk Difference (M‐H, Random, 95% CI)	‐0.04 [‐0.07, ‐0.02]

3.1 Males	12	1789	Risk Difference (M‐H, Random, 95% CI)	‐0.05 [‐0.08, ‐0.02]
3.2 Females	13	1880	Risk Difference (M‐H, Random, 95% CI)	‐0.06 [‐0.10, ‐0.01]
4 Depressive disorders (by risk) Show forest plot	2	146	Risk Difference (M‐H, Random, 95% CI)	‐0.06 [‐0.17, 0.05]

4.1 High Risk	2	76	Risk Difference (M‐H, Random, 95% CI)	‐0.15 [‐0.27, ‐0.02]
4.2 Low Risk	2	70	Risk Difference (M‐H, Random, 95% CI)	0.0 [‐0.07, 0.07]
5 Depression scores (by population) Show forest plot	63	13799	Std. Mean Difference (IV, Random, 95% CI)	‐0.20 [‐0.26, ‐0.14]

5.1 Targeted	32	4174	Std. Mean Difference (IV, Random, 95% CI)	‐0.31 [‐0.41, ‐0.21]
5.2 Universal	31	9625	Std. Mean Difference (IV, Random, 95% CI)	‐0.10 [‐0.16, ‐0.04]
6 Depression scores (by intervention) Show forest plot	51	10474	Std. Mean Difference (IV, Random, 95% CI)	‐0.21 [‐0.28, ‐0.15]

6.1 Psychological	51	10474	Std. Mean Difference (IV, Random, 95% CI)	‐0.21 [‐0.28, ‐0.15]
7 Depression scores (by sex) Show forest plot	40	13350	Std. Mean Difference (IV, Random, 95% CI)	‐0.10 [‐0.19, ‐0.01]

7.1 Males	37	6361	Std. Mean Difference (IV, Random, 95% CI)	‐0.15 [‐0.24, ‐0.06]
7.2 Females	37	6989	Std. Mean Difference (IV, Random, 95% CI)	‐0.05 [‐0.21, 0.11]
8 Depression scores (by risk) Show forest plot	14	5944	Std. Mean Difference (IV, Random, 95% CI)	‐0.12 [‐0.20, ‐0.04]

8.1 High Risk	14	1979	Std. Mean Difference (IV, Random, 95% CI)	‐0.16 [‐0.29, ‐0.03]
8.2 Low Risk	14	3965	Std. Mean Difference (IV, Random, 95% CI)	‐0.10 [‐0.21, ‐0.00]

Comparison 1. Psychological/educational intervention versus no intervention/wait‐list/usual care

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Comparison 2. Psychological/educational intervention versus placebo/attention/other intervention

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depressive disorder (by population) Show forest plot	1	125	Risk Difference (M‐H, Random, 95% CI)	‐0.07 [‐0.19, 0.04]

1.1 Targeted	1	125	Risk Difference (M‐H, Random, 95% CI)	‐0.07 [‐0.19, 0.04]
2 Depressive disorder (by intervention) Show forest plot	1	125	Risk Difference (M‐H, Random, 95% CI)	‐0.07 [‐0.19, 0.04]

2.1 Psychological	1	125	Risk Difference (M‐H, Random, 95% CI)	‐0.07 [‐0.19, 0.04]
3 Depression scores (by population) Show forest plot	6	607	Std. Mean Difference (IV, Random, 95% CI)	‐0.05 [‐0.21, 0.11]

3.1 Targeted	3	231	Std. Mean Difference (IV, Random, 95% CI)	‐0.14 [‐0.40, 0.12]
3.2 Universal	3	376	Std. Mean Difference (IV, Random, 95% CI)	‐0.00 [‐0.21, 0.20]
4 Depression scores (by intervention) Show forest plot	5	563	Std. Mean Difference (IV, Random, 95% CI)	‐0.02 [‐0.19, 0.14]

4.1 Psychological	5	563	Std. Mean Difference (IV, Random, 95% CI)	‐0.02 [‐0.19, 0.14]
5 Depression scores (by gender) Show forest plot	1	235	Std. Mean Difference (IV, Random, 95% CI)	‐0.05 [‐0.31, 0.21]

5.1 Males	1	125	Std. Mean Difference (IV, Random, 95% CI)	‐0.00 [‐0.36, 0.35]
5.2 Females	1	110	Std. Mean Difference (IV, Random, 95% CI)	‐0.10 [‐0.48, 0.27]

Comparison 2. Psychological/educational intervention versus placebo/attention/other intervention

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Comparison 3. Psychological/educational intervention versus no intervention/wait‐list/usual care three to nine months

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depressive disorder (by population) Show forest plot	19	1842	Risk Difference (M‐H, Random, 95% CI)	‐0.11 [‐0.16, ‐0.06]

1.1 Targeted	10	1306	Risk Difference (M‐H, Random, 95% CI)	‐0.06 [‐0.10, ‐0.03]
1.2 Universal	9	536	Risk Difference (M‐H, Random, 95% CI)	‐0.19 [‐0.33, ‐0.05]
2 Depressive disorder (by intervention) Show forest plot	18	1688	Risk Difference (M‐H, Random, 95% CI)	‐0.12 [‐0.17, ‐0.06]

2.1 Educational	0	0	Risk Difference (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
2.2 Psychological	18	1688	Risk Difference (M‐H, Random, 95% CI)	‐0.12 [‐0.17, ‐0.06]
3 Depressive disorder (by sex) Show forest plot	11	1570	Risk Difference (M‐H, Random, 95% CI)	‐0.03 [‐0.06, ‐0.00]

3.1 Males	10	770	Risk Difference (M‐H, Random, 95% CI)	‐0.03 [‐0.08, 0.01]
3.2 Females	11	800	Risk Difference (M‐H, Random, 95% CI)	‐0.04 [‐0.08, 0.00]
4 Depressive disorder (by risk) Show forest plot	6	1142	Risk Difference (M‐H, Random, 95% CI)	‐0.05 [‐0.09, ‐0.01]

4.1 High Risk	6	916	Risk Difference (M‐H, Random, 95% CI)	‐0.06 [‐0.11, ‐0.00]
4.2 Low Risk	3	226	Risk Difference (M‐H, Random, 95% CI)	‐0.04 [‐0.15, 0.07]
5 Depression scores (by population) Show forest plot	43	6999	Std. Mean Difference (IV, Random, 95% CI)	‐0.16 [‐0.23, ‐0.10]

5.1 Targeted	24	3146	Std. Mean Difference (IV, Random, 95% CI)	‐0.22 [‐0.32, ‐0.12]
5.2 Universal	19	3853	Std. Mean Difference (IV, Random, 95% CI)	‐0.09 [‐0.17, ‐0.02]
6 Depression scores (by intervention) Show forest plot	39	6219	Std. Mean Difference (IV, Random, 95% CI)	‐0.17 [‐0.24, ‐0.11]

6.1 Psychological	39	6219	Std. Mean Difference (IV, Random, 95% CI)	‐0.17 [‐0.24, ‐0.11]
7 Depression scores (by sex) Show forest plot	27	7286	Std. Mean Difference (IV, Random, 95% CI)	‐0.04 [‐0.17, 0.08]

7.1 Males	26	3392	Std. Mean Difference (IV, Random, 95% CI)	‐0.19 [‐0.27, ‐0.12]
7.2 Females	27	3894	Std. Mean Difference (IV, Random, 95% CI)	0.09 [‐0.13, 0.31]
8 Depression scores (by risk) Show forest plot	9	2813	Std. Mean Difference (IV, Random, 95% CI)	‐0.03 [‐0.14, 0.07]

8.1 High Risk	9	668	Std. Mean Difference (IV, Random, 95% CI)	0.03 [‐0.15, 0.22]
8.2 Low Risk	9	2145	Std. Mean Difference (IV, Random, 95% CI)	‐0.07 [‐0.20, 0.06]

Comparison 3. Psychological/educational intervention versus no intervention/wait‐list/usual care three to nine months

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Comparison 4. Psychological/educational intervention versus placebo/attention/other intervention three to nine months

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depression scores (by population) Show forest plot	4	437	Std. Mean Difference (IV, Random, 95% CI)	0.07 [‐0.12, 0.26]

1.1 Targeted	1	66	Std. Mean Difference (IV, Random, 95% CI)	0.06 [‐0.42, 0.55]
1.2 Universal	3	371	Std. Mean Difference (IV, Random, 95% CI)	0.01 [‐0.31, 0.33]
2 Depression scores (by intervention) Show forest plot	4	437	Std. Mean Difference (IV, Random, 95% CI)	0.07 [‐0.12, 0.26]

2.1 Educational	0	0	Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2.2 Psychological	4	437	Std. Mean Difference (IV, Random, 95% CI)	0.07 [‐0.12, 0.26]

Comparison 4. Psychological/educational intervention versus placebo/attention/other intervention three to nine months

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Comparison 5. Psychological/educational intervention versus no intervention/wait‐list/usual care 12 months

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depressive disorder (by population) Show forest plot	11	2283	Risk Difference (M‐H, Random, 95% CI)	‐0.06 [‐0.11, ‐0.01]

1.1 Targeted	3	239	Risk Difference (M‐H, Random, 95% CI)	‐0.14 [‐0.24, ‐0.04]
1.2 Universal	8	2044	Risk Difference (M‐H, Random, 95% CI)	‐0.04 [‐0.09, 0.02]
2 Depressive disorder (by intervention) Show forest plot	11	2270	Risk Difference (M‐H, Random, 95% CI)	‐0.12 [‐0.19, ‐0.04]

2.1 Psychological	11	2270	Risk Difference (M‐H, Random, 95% CI)	‐0.12 [‐0.19, ‐0.04]
3 Depressive disorder (by sex) Show forest plot	5	2048	Risk Difference (M‐H, Random, 95% CI)	‐0.01 [‐0.04, 0.03]

3.1 Males	5	948	Risk Difference (M‐H, Random, 95% CI)	0.02 [‐0.02, 0.05]
3.2 Females	5	1100	Risk Difference (M‐H, Random, 95% CI)	‐0.02 [‐0.09, 0.04]
4 Depressive disorder (by risk) Show forest plot	3	346	Risk Difference (M‐H, Random, 95% CI)	0.01 [‐0.05, 0.06]

4.1 High Risk	3	288	Risk Difference (M‐H, Random, 95% CI)	0.01 [‐0.06, 0.08]
4.2 Low Risk	2	58	Risk Difference (M‐H, Random, 95% CI)	0.0 [‐0.08, 0.08]
5 Depression scores (by population) Show forest plot	24	6463	Std. Mean Difference (IV, Random, 95% CI)	‐0.10 [‐0.18, ‐0.02]

5.1 Targeted	8	1351	Std. Mean Difference (IV, Random, 95% CI)	‐0.20 [‐0.37, ‐0.04]
5.2 Universal	16	5112	Std. Mean Difference (IV, Random, 95% CI)	‐0.05 [‐0.14, 0.03]
6 Depression scores (by intervention) Show forest plot	22	6354	Std. Mean Difference (IV, Random, 95% CI)	‐0.10 [‐0.18, ‐0.02]

6.1 Psychological	22	6354	Std. Mean Difference (IV, Random, 95% CI)	‐0.10 [‐0.18, ‐0.02]
7 Depression scores (by sex) Show forest plot	16	5130	Std. Mean Difference (IV, Random, 95% CI)	‐0.06 [‐0.14, 0.03]

7.1 Males	14	2317	Std. Mean Difference (IV, Random, 95% CI)	‐0.07 [‐0.21, 0.07]
7.2 Females	16	2813	Std. Mean Difference (IV, Random, 95% CI)	‐0.05 [‐0.17, 0.06]
8 Depression scores (by risk) Show forest plot	8	2695	Std. Mean Difference (IV, Random, 95% CI)	0.01 [‐0.08, 0.09]

8.1 High Risk	8	737	Std. Mean Difference (IV, Random, 95% CI)	0.02 [‐0.14, 0.17]
8.2 Low Risk	8	1958	Std. Mean Difference (IV, Random, 95% CI)	0.00 [‐0.10, 0.10]

Comparison 5. Psychological/educational intervention versus no intervention/wait‐list/usual care 12 months

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Comparison 6. Psychological/educational intervention versus placebo/attention/other intervention 12 months

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depression scores (by population) Show forest plot	1	295	Std. Mean Difference (IV, Random, 95% CI)	‐0.07 [‐0.30, 0.16]

1.1 Universal	1	295	Std. Mean Difference (IV, Random, 95% CI)	‐0.07 [‐0.30, 0.16]
2 Depression scores (by intervention) Show forest plot	1	295	Std. Mean Difference (IV, Random, 95% CI)	‐0.07 [‐0.30, 0.16]

2.1 Psychological	1	295	Std. Mean Difference (IV, Random, 95% CI)	‐0.07 [‐0.30, 0.16]
3 Depression scores (by sex) Show forest plot	1	212	Std. Mean Difference (IV, Random, 95% CI)	‐0.10 [‐0.46, 0.27]

3.1 Males	1	109	Std. Mean Difference (IV, Random, 95% CI)	0.09 [‐0.29, 0.46]
3.2 Females	1	103	Std. Mean Difference (IV, Random, 95% CI)	‐0.28 [‐0.67, 0.11]

Comparison 6. Psychological/educational intervention versus placebo/attention/other intervention 12 months

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Comparison 7. Psychological/educational intervention versus no intervention/wait‐list/usual care 24 months

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depressive disorder (by population) Show forest plot	8	2084	Risk Difference (M‐H, Random, 95% CI)	‐0.01 [‐0.04, 0.03]

1.1 Targeted	2	313	Risk Difference (M‐H, Random, 95% CI)	‐0.01 [‐0.10, 0.09]
1.2 Universal	6	1771	Risk Difference (M‐H, Random, 95% CI)	‐0.01 [‐0.05, 0.03]
2 Depressive disorder (by intervention) Show forest plot	7	1849	Risk Difference (M‐H, Random, 95% CI)	‐0.01 [‐0.04, 0.03]

2.1 Psychological	7	1849	Risk Difference (M‐H, Random, 95% CI)	‐0.01 [‐0.04, 0.03]
3 Depressive disorder (by sex) Show forest plot	4	1903	Risk Difference (M‐H, Random, 95% CI)	‐0.00 [‐0.03, 0.02]

3.1 Males	4	909	Risk Difference (M‐H, Random, 95% CI)	‐0.01 [‐0.04, 0.03]
3.2 Females	4	994	Risk Difference (M‐H, Random, 95% CI)	‐0.00 [‐0.05, 0.04]
4 Depressive disorder (by risk) Show forest plot	3	345	Risk Difference (M‐H, Random, 95% CI)	‐0.02 [‐0.08, 0.04]

4.1 High Risk	3	167	Risk Difference (M‐H, Random, 95% CI)	‐0.10 [‐0.21, 0.01]
4.2 Low Risk	3	178	Risk Difference (M‐H, Random, 95% CI)	0.02 [‐0.05, 0.09]
5 Depression scores (by population) Show forest plot	14	3599	Std. Mean Difference (IV, Random, 95% CI)	‐0.01 [‐0.08, 0.05]

5.1 Targeted	4	598	Std. Mean Difference (IV, Random, 95% CI)	0.03 [‐0.13, 0.19]
5.2 Universal	10	3001	Std. Mean Difference (IV, Random, 95% CI)	‐0.03 [‐0.12, 0.05]
6 Depression scores (by intervention) Show forest plot	13	3215	Std. Mean Difference (IV, Random, 95% CI)	‐0.02 [‐0.09, 0.05]

6.1 Psychological	13	3215	Std. Mean Difference (IV, Random, 95% CI)	‐0.02 [‐0.09, 0.05]
7 Depression scores (by sex) Show forest plot	8	3359	Std. Mean Difference (IV, Random, 95% CI)	0.05 [‐0.13, 0.24]

7.1 Males	8	1589	Std. Mean Difference (IV, Random, 95% CI)	‐0.05 [‐0.15, 0.05]
7.2 Females	8	1770	Std. Mean Difference (IV, Random, 95% CI)	0.18 [‐0.17, 0.53]
8 Depression scores (by risk) Show forest plot	4	1142	Std. Mean Difference (IV, Random, 95% CI)	‐0.01 [‐0.18, 0.17]

8.1 High Risk	4	308	Std. Mean Difference (IV, Random, 95% CI)	0.08 [‐0.36, 0.51]
8.2 Low Risk	4	834	Std. Mean Difference (IV, Random, 95% CI)	‐0.07 [‐0.21, 0.06]

Comparison 7. Psychological/educational intervention versus no intervention/wait‐list/usual care 24 months

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Comparison 8. Psychological/educational intervention versus placebo/attention/other intervention 24 months

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depression scores (by population) Show forest plot	1	263	Std. Mean Difference (IV, Random, 95% CI)	‐0.05 [‐0.29, 0.19]

1.1 Universal	1	263	Std. Mean Difference (IV, Random, 95% CI)	‐0.05 [‐0.29, 0.19]
2 Depression scores (by intervention) Show forest plot	1	263	Std. Mean Difference (IV, Random, 95% CI)	‐0.05 [‐0.29, 0.19]

2.1 Psychological	1	263	Std. Mean Difference (IV, Random, 95% CI)	‐0.05 [‐0.29, 0.19]

Comparison 8. Psychological/educational intervention versus placebo/attention/other intervention 24 months

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Comparison 9. Psychological/educational intervention versus no intervention/wait‐list/usual care 36 months

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depressive disorder (by population) Show forest plot	2	464	Risk Difference (M‐H, Random, 95% CI)	‐0.10 [‐0.19, ‐0.02]

1.1 Targeted	1	225	Risk Difference (M‐H, Random, 95% CI)	‐0.08 [‐0.21, 0.05]
1.2 Universal	1	239	Risk Difference (M‐H, Random, 95% CI)	‐0.12 [‐0.22, ‐0.01]
2 Depressive disorder (by intervention) Show forest plot	2	464	Risk Difference (M‐H, Random, 95% CI)	‐0.10 [‐0.19, ‐0.02]

2.1 Psychological	2	464	Risk Difference (M‐H, Random, 95% CI)	‐0.10 [‐0.19, ‐0.02]
3 Depression scores (by population) Show forest plot	6	1203	Std. Mean Difference (IV, Random, 95% CI)	‐0.09 [‐0.21, 0.02]

3.1 Targeted	2	301	Std. Mean Difference (IV, Random, 95% CI)	‐0.24 [‐0.47, ‐0.02]
3.2 Universal	4	902	Std. Mean Difference (IV, Random, 95% CI)	‐0.04 [‐0.17, 0.09]
4 Depression scores (by intervention) Show forest plot	6	1203	Std. Mean Difference (IV, Random, 95% CI)	‐0.09 [‐0.21, 0.02]

4.1 Psychological	6	1203	Std. Mean Difference (IV, Random, 95% CI)	‐0.09 [‐0.21, 0.02]
5 Depression scores (by sex) Show forest plot	2	816	Std. Mean Difference (IV, Random, 95% CI)	‐0.06 [‐0.20, 0.08]

5.1 Males	2	395	Std. Mean Difference (IV, Random, 95% CI)	‐0.03 [‐0.23, 0.17]
5.2 Females	2	421	Std. Mean Difference (IV, Random, 95% CI)	‐0.09 [‐0.30, 0.12]
6 Depression scores (by risk) Show forest plot	1	524	Std. Mean Difference (IV, Random, 95% CI)	‐0.03 [‐0.20, 0.14]

6.1 High Risk	1	171	Std. Mean Difference (IV, Random, 95% CI)	‐0.10 [‐0.41, 0.20]
6.2 Low Risk	1	353	Std. Mean Difference (IV, Random, 95% CI)	0.01 [‐0.20, 0.22]

Comparison 9. Psychological/educational intervention versus no intervention/wait‐list/usual care 36 months

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