Cognitive behavioural therapy (CBT), third‐wave CBT and interpersonal therapy (IPT) based interventions for preventing depression in children and adolescents

Sarah E Hetrick; Georgina R Cox; Katrina G Witt; Julliet J Bir; Sally N Merry

doi:10.1002/14651858.CD003380.pub4

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Figure 1

PRISMA diagram

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Figure 2

'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 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Figure 4

Forest plot of comparison: 1 Psychological intervention versus any comparison post‐intervention, outcome: 1.3 Depressive disorder medium‐term follow‐up (primary outcomes).

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Figure 5

Forest plot of comparison: 1 Psychological intervention versus any comparison post‐intervention, outcome: 1.5 Depression scores (self‐report) post‐intervention follow‐up (primary outcome).

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Figure 6

Funnel plot of analysis 1.4: Psychological intervention versus any comparison post‐intervention for depressive disorder at the medium‐term follow‐up.

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Figure 7

Funnel plot of analysis 1.6: Psychological intervention versus any comparison post‐intervention for depression scores at the post‐intervention assessment.

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Analysis 1.1

Comparison 1 Psychological intervention versus any comparison, Outcome 1 Depressive diagnosis (by population) post‐intervention.

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Analysis 1.2

Comparison 1 Psychological intervention versus any comparison, Outcome 2 Depressive diagnosis short‐term follow‐up.

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Analysis 1.3

Comparison 1 Psychological intervention versus any comparison, Outcome 3 Depressive diagnosis medium‐term follow‐up.

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Analysis 1.4

Comparison 1 Psychological intervention versus any comparison, Outcome 4 Depressive diagnosis long‐term follow‐up.

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Analysis 1.5

Comparison 1 Psychological intervention versus any comparison, Outcome 5 Depression symptoms (by population) post‐intervention.

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Analysis 1.6

Comparison 1 Psychological intervention versus any comparison, Outcome 6 Depression symptoms short‐term follow‐up.

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Analysis 1.7

Comparison 1 Psychological intervention versus any comparison, Outcome 7 Depression symptoms medium‐term follow‐up.

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Analysis 1.8

Comparison 1 Psychological intervention versus any comparison, Outcome 8 Depression symptoms long‐term follow‐up.

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Analysis 1.9

Comparison 1 Psychological intervention versus any comparison, Outcome 9 Depression symptoms clinician‐rated (by population) post‐intervention.

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Analysis 1.10

Comparison 1 Psychological intervention versus any comparison, Outcome 10 Depression symptoms clinician‐rated medium‐term follow‐up.

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Analysis 1.11

Comparison 1 Psychological intervention versus any comparison, Outcome 11 Depression symptoms clinician‐rated long‐term follow‐up.

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Analysis 1.12

Comparison 1 Psychological intervention versus any comparison, Outcome 12 Anxiety symptoms (by population) post‐intervention.

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Analysis 1.13

Comparison 1 Psychological intervention versus any comparison, Outcome 13 Anxiety symptoms (by population) short‐term follow‐up.

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Analysis 1.14

Comparison 1 Psychological intervention versus any comparison, Outcome 14 Anxiety symptoms (by population) medium‐term follow‐up.

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Analysis 1.15

Comparison 1 Psychological intervention versus any comparison, Outcome 15 Anxiety symptoms (by population) long‐term follow‐up.

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Analysis 1.16

Comparison 1 Psychological intervention versus any comparison, Outcome 16 Social and general functioning (by population) post‐intervention.

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Analysis 1.17

Comparison 1 Psychological intervention versus any comparison, Outcome 17 Social and general functioning (by population) short‐term follow‐up.

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Analysis 1.18

Comparison 1 Psychological intervention versus any comparison, Outcome 18 Social and general functioning (by population) medium‐term follow‐up.

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Analysis 1.19

Comparison 1 Psychological intervention versus any comparison, Outcome 19 Social and general functioning (by population) long‐term follow‐up.

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Analysis 2.1

Comparison 2 Psychological intervention versus any comparison for targeted interventions, Outcome 1 Depressive diagnosis medium‐term follow‐up.

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Analysis 2.2

Comparison 2 Psychological intervention versus any comparison for targeted interventions, Outcome 2 Depression symptoms post‐intervention.

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Analysis 2.3

Comparison 2 Psychological intervention versus any comparison for targeted interventions, Outcome 3 Depression symptoms medium‐term follow‐up.

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Analysis 3.1

Comparison 3 Psychological intervention versus any comparison for universal interventions, Outcome 1 Depressive diagnosis medium‐term follow‐up.

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Analysis 3.2

Comparison 3 Psychological intervention versus any comparison for universal interventions, Outcome 2 Depression symptoms post‐intervention.

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Analysis 3.3

Comparison 3 Psychological intervention versus any comparison for universal interventions, Outcome 3 Depression symptoms medium‐term follow‐up.

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Analysis 4.1

Comparison 4 Psychological intervention versus any comparison for selected and indicated interventions, Outcome 1 Depressive diagnosis medium‐term follow‐up.

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Analysis 4.2

Comparison 4 Psychological intervention versus any comparison for selected and indicated interventions, Outcome 2 Depression symptoms (by population) post‐intervention.

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Analysis 5.1

Comparison 5 Self‐reported depression symptoms versus clinician‐rated depression symptoms, Outcome 1 Depression scores (by assessor) post‐intervention.

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Analysis 5.2

Comparison 5 Self‐reported depression symptoms versus clinician‐rated depression symptoms, Outcome 2 Depression scores medium‐term follow‐up.

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Analysis 5.3

Comparison 5 Self‐reported depression symptoms versus clinician‐rated depression symptoms, Outcome 3 Depression scores long‐term follow‐up.

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Summary of findings for the main comparison. Evidence‐based psychological interventions versus any comparator for depression diagnosis at the medium‐term follow‐up

Evidence‐based psychological interventions compared to any comparator for depression diagnosis at the medium‐term follow‐up
Patient or population: children and adolescents Settings: various Intervention: evidence‐based psychological interventions (targeted and universal) Comparison: any
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Any comparator	Evidence‐based psychological interventions
Evidence‐based psychological interventions versus any comparator (Overall) ‐ effect on diagnosis of depression The assumed risk is based on control group rates of depression diagnosis at medium‐term follow‐up (from a rank ordering of control group rates of each included study).	Study population		RR 0.84 (0.72 to 0.97)	⊕⊕⊕⊝ Moderate¹	—
	193 per 1000	162 per 1000 (139 to 187)
	Low (0%)
		0 per 1000 (0 to 0)
	Moderate (18.5%)
	185 per 1000	155 per 1000 (133 to 180)
	High (70.7%)
	707 per 1000	594 per 1000 (509 to 685)
Evidence‐based psychological interventions versus any comparator (Targeted programmes) ‐ effect on diagnosis of depression The assumed risk is based on control group rates of depression diagnosis at medium‐term follow‐up (from a rank ordering of control group rates of each included study).	Study population		RR 0.82 (0.68 to 0.99)	⊕⊝⊝⊝ Very low^1,2,3	—
	243 per 1000	199 per 1000 (165 to 240)
	Low (0%)
		0 per 1000 (0 to 0)
	Moderate (20.4%)
	204 per 1000	167 per 1000 (139 to 202)
	High (76.7%)
	767 per 1000	629 per 1000 (521 to 759)
Evidence‐based psychological interventions versus any comparator (Universal programmes) ‐ effect on diagnosis of depression The assumed risk is based on control group rates of depression diagnosis at medium‐term follow‐up (from a rank ordering of control group rates of each included study).	Study population		RR 0.87 (0.66 to 1.14)	⊕⊕⊕⊝ Moderate⁴	—
	99 per 1000	86 per 1000 (65 to 113)
	Low (1.0%)
	10 per 1000	9 per 1000 (7 to 12)
	Moderate (14.5%)
	144 per 1000	125 per 1000 (95 to 164)
	High (30.8%)
	308 per 1000	268 per 1000 (203 to 351)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹We downgraded quality owing to lack of clarity over allocation concealment and presence of other bias. ²Heterogeneity (I² = 53%). ³Omitting trials in which the outcome was measured indirectly (i.e. using cut‐points from self‐rated depression symptom inventories) caused the treatment effect for targeted depression prevention programmes to become non‐significant (RD ‐0.04, 95% CI ‐0.08 to 0.00; k = 15; n = 2783). ⁴We downgraded quality owing to a lack of clarity over random sequence generation and allocation concealment.

Summary of findings for the main comparison. Evidence‐based psychological interventions versus any comparator for depression diagnosis at the medium‐term follow‐up

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Summary of findings 2. Evidence‐based psychological interventions versus any comparator for self‐reported depression scores at the post‐intervention assessment

Evidence‐based psychological interventions versus any comparator for self‐rated depression scores at the post‐intervention assessment
Patient or population: children and adolescents Settings: various Intervention: evidence‐based psychological interventions (targeted and universal) Comparison: any
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Any comparator	Evidence‐based psychological interventions
Evidence‐based psychological interventions versus any comparator (Overall) ‐ self‐rated depression scores (higher score is equivalent to a poorer outcome)	The mean self‐reported depression score ranged across control groups from 0.66 to 105.51 points.	The mean self‐rated depression score in the intervention group was 0.21 standard deviations lower (0.27 to 0.15 lower)	—	13,829 (73 trials)	⊕⊕⊝⊝ Low^1,2	—
Evidence‐based psychological interventions versus any comparator (Targeted ‐ self‐rated depression scores (higher score is equivalent to a poorer outcome))	The mean self‐reported depression score ranged across control groups from 4.30 to 105.51 points.	The mean self‐rated depression score in the intervention group was 0.32 standard deviations lower (0.42 to 0.23 lower)	—	4816 (42 trials)	⊕⊕⊕⊝ Moderate³	—
Evidence‐based psychological interventions versus any comparator (Universal programmes) ‐ self‐rated depression scores (higher score is equivalent to a poorer outcome)	The mean self‐reported depression score ranged across control groups from 0.66 to 50.49 points.	The mean self‐rated depression score in the intervention group was 0.11 standard deviations lower (0.17 to 0.05 lower)	—	9013 (31 trials)	⊕⊕⊕⊝ Moderate¹	—
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹We downgraded quality owing to a lack of clarity about random sequence generation and allocation concealment and the presence of other bias. ²Heterogeneity (I² = 57%). ³We downgraded quality owing to a lack of clarity over allocation concealment and the presence of other bias.

Summary of findings 2. Evidence‐based psychological interventions versus any comparator for self‐reported depression scores at the post‐intervention assessment

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Table 1. Classification of intervention components

Study	Cognitive restructuring (Y/N)	Behavioural techniques (Y/N)	Problem‐solving (Y/N)	Social skills training (Y/N)	Relaxation techniques (Y/N)	Third wave techniques (Y/N)	Anxiety management techniques (Y/N)	Component/s focusing on management of specific problems (Y/N)	Parental component/s (Y/N)	Predominant therapeutic focus
Araya 2013	Y	N	Y	N	N	N	N	N	Y	CBT (cognitive)
Arnarson 2009	Y	Y	Y	Y	Y	N	N	N	N	CBT plus IPT
Bella‐Awusah 2015	Y	Y	N	N	Y	N	N	N	N	CBT (behavioural)
Calear 2009	Y	Y	Y	Y	Y	N	N	N	N	CBT (cognitive and behavioural)
Cardemil 2002	Y	N	Y	Y	N	N	N	N	N	CBT (cognitive)
Castellanos 2006	Y	N	N	N	N	N	N	N	N	CBT (cognitive)
Chaplin 2006	Y	N	Y	Y	Y	N	N	Y¹	N	CBT (cognitive)
Charbonneau 2012	N	N	N	N	Y	Y	N	N	N	Third wave
Clarke 1993	N	Y	N	N	N	N	N	N	N	Behaviour therapy (third wave)
Clarke 1995	Y	N	N	N	N	N	N	N	N	CBT (cognitive)
Clarke 2001	Y	N	N	N	N	N	N	Y²	Y	CBT (cognitive)
Compas 2009	Y	Y	N	N	N	Y	N	Y²	Y	CBT (cognitive and behavioural)
Cova 2011‐Targeted	Y	N	Y	Y	Y	Y	Y	Y³	N	CBT (cognitive)
Cowell 2009	N	N	Y	Y	N	N	N	Y⁴	Y
Dobson 2010	Y	N	N	N	N	N	N	N	N	CBT (cognitive)
Ellis 2011	Y	Y	Y	Y	Y	N	N	N	N	CBT (cognitive and behavioural)
Fleming 2012	Y	Y	Y	Y	Y	N	N	N	N	CBT (cognitive and behavioural)
Fresco 2009	Y	N	N	N	N	N	N	N	N	CBT (cognitive)
Gallegos 2008	Y	N	Y	N	Y	N	Y	N	Y	CBT (cognitive)
Garber 2009	Y	N	N	N	N	N	N	N	Y	CBT (cognitive)
Garcia 2011	Y	N	Y	Y	Y	Y	Y	Unclear	Unclear	Third wave
Gilham 1994‐Study 2	Y	N	Y	Y	Y	N	N	Y	N⁵	CBT (cognitive)
Gillham, Hamilton 2006a	Y	N	Y	Y	Y	N	N	Unclear	N	CBT (cognitive)
Gillham, Reivich 2006b	Y	N	Y	Y	Y	N	N	Unclear	Y	CBT (cognitive)
Gillham 2007	Y	N	Y	Y	Y	N	N	Unclear	N	CBT (cognitive)
Gillham 2012	Y	N	N	Y	Y	N	N	Y	N	CBT (cognitive)
Horowitz a2007	Y	N	N	N	N	N	N	N	N	CBT (cognitive)
Horowitz b2007	N	N	N	Y	N	N	N	N	N	IPT
Hyun 2005	Y	Y	N	N	Y	N	N	Y⁶	N	CBT (cognitive and behavioural)
Jaycox 1994	Y	N	Y	Y	Y	N	N	Y⁷	N	CBT (cognitive)
Karami 2012	Y	N	Y	Y	Y	N	N	Y⁸	N	CBT (cognitive)
Kauer 2012	N	Y	N	N	N	N	N	N	N	Behaviour therapy (third wave)
Khalsa 2012	N	N	N	N	Y	Y	N	N	N	Third wave
Kindt 2014	Y	N	N	Y	Y	N	N	N	N	CBT (cognitive)
Kowalenko 2005	Y	Y	Y	Y	N	N	N	N	N	CBT (cognitive and behavioural)
Liehr 2010	N	N	N	N	N	Y	N	N	N	Third wave
Lillevoll 2014	Y	Y	Y	Y	Y	N	N	N	N	CBT (cognitive and behavioural)
Livheim 2014‐study 1(girls)	N	N	N	N	N	Y	N	N	N	Third wave
Makarushka 2012	Y	Y	N	N	N	N	N	N	N	CBT (cognitive and behavioural)
Manicavasagar 2014	Unclear	Unclear	N	N	Y	Y	N	N	N	Third wave
McCarty 2011	Y	Y	Y	Y	Y	N	N	N	Y	CBT (cognitive and behavioural)
McCarty 2013	Y	Y	Y	Y	Y	N	N	N	Y	CBT (cognitive and behavioural)
McLaughlin 2011	Y	Y	Y	Y	Y	N	N	N	N	CBT (cognitive and behavioural)
Mendelson 2010	N	N	N	N	N	Y	N	N	N	Third wave
Merry 2004	Y	Y	Y	Y	Y	N	Y	N	N	CBT plus IPT
Mirzamani 2012	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Noël 2013	Y	Y	Y	Y	N	N	N	Y⁹	N	CBT (cognitive and behavioural)
O'Leary‐Barrett 2013	Y	N	N	N	N	N	N	N	N	CBT (cognitive)
Pattison 2001	Y	N	Y	Y	Y	N	N	Unclear	N	CBT (cognitive)
Petersen 1997	Y	N	Y	Y	Y	N	N	N	N	Problem‐solving
Pössel 2004	Y	N	N	Y	N	N	N	N	N	CBT (cognitive)
Pössel 2008	Y	Y	N	Y	N	N	N	N	N	CBT (cognitive and behavioural)
Pössel 2013	Y	Y	N	Y	N	N	N	N	N	CBT (cognitive and behavioural)
Puskar 2003	Y	Y	Y	Y	Y	N	N	N	N	CBT (cognitive and behavioural)
Quayle 2001	Y	N	Y	Y	N	N	N	Y¹	N	CBT (cognitive)
Reynolds 2011	N	Y	N	N	N	N	N	N	N	Behaviour therapy (third wave)
Rivet‐Duval 2010	Y	Y	Y	Y	Y	N	Y	N	N	CBT plus IPT
Roberts 2003	Y	N	Y	Y	N	N	N	Y¹	N	CBT (cognitive)
Roberts 2010	Y	Y	Y	Y	N	N	Unclear	Unclear	N	CBT (cognitive)
Rohde 2014a	Y	Y	N	N	N	N	N	N	N	CBT (cognitive and behavioural)
Rohde 2014b	Y	Y	N	N	N	N	N	N	N	CBT (cognitive and behavioural)
Rooney 2006	Y	N	N	N	Y	N	N	N	N	CBT (cognitive)
Rooney 2013	Y	Y	N	N	Y	N	Y	N	N	CBT (cognitive and behavioural)
Rose 2014	Y	Y	Y	Y	N	N	Unclear	N	N	CBT plus IPT
Sawyer 2010	Y	Y	Y	Y	Y	N	N	N	N	CBT (cognitive and behavioural)
Schmiege 2006	Y	Y	Y	Y	N	N	N	Y¹⁰	Y	CBT (cognitive)
Seligman 1999	Y	Y	Y	Y	Y	N	N	N	N	CBT (cognitive and behavioural)
Seligman 2007	Y	Y	Y	Y	Y	N	N	N	N	CBT (cognitive and behavioural)
Sethi 2010	Y	Y	Y	Y	Y	N	N	N	N	CBT (cognitive and behavioural)
Shatte 1997	Y	N	Y	Y	Y	N	N	Y⁶	N	CBT (cognitive)
Sheffield a2006	Y	Y	Y	Y	N	N	N	N	N	CBT (cognitive and behavioural)
Sheffield b2006	Y	Y	Y	Y	N	N	N	N	N	CBT (cognitive and behavioural)
Sheffield c2006	Y	N	Y	N	N	N	N	N	N	CBT (cognitive)
Snyder 2010	N	N	N	N	N	Y	N	N	N	Third wave
Spence 2003	Y	N	Y	N	N	N	N	N	N	CBT (cognitive and behavioural)
Stallard 2012a	Y	Y	Y	Y	Y	N	Y	N	N	CBT plus IPT
Stice 2006	Y	Y	N	N	N	N	N	N	N	CBT (cognitive and behavioural)
Stice 2008	Y	Y	N	N	N	N	Y	N	N	CBT (cognitive and behavioural)
Stoppelbein 2003	Y	Y	N	N	Y	N	N	N	N	CBT (cognitive and behavioural)
Whittaker 2012	Y	Y	Y	N	Y	N	N	N	N	CBT (cognitive and behavioural)
Wijnhoven 2014	Y	N	N	N	N	N	N	N	N	CBT (cognitive)
Wong 2014	Y	Y	Y	Y	Y	N	N	N	N	CBT (cognitive and behavioural)
Woods 2011	Y	Y	Y	Y	N	N	N	N	N	CBT (cognitive and behavioural)
Young 2006	N	N	N	Y	N	N	N	N	N	IPT
Young 2010a	N	N	N	Y	N	N	N	N	N	IPT
Yu 2002‐study 3	Y	N	Y	Y	Y	N	N	Y¹	N	CBT (cognitive)
¹Penn Resiliency programmes place some emphasis on resolution of family conflict. ²Addresses beliefs related to or coping with a parent diagnosed with depression, or both. ³Addresses resolving conflict with family and friends. 4 Addresses being an immigrant ⁵Although for some participants there was a parental component, this was not controlled. Instead only the feasibility of offering parental sessions was evaluated. ⁶Addresses factors involved in the participants' decision to run away from home. ⁷Addresses coping with parental conflict. ⁸Addresses coping with parental divorce. ⁹Addresses coping with rural living. ¹⁰Addresses coping with grief after the death of a parent.

Table 1. Classification of intervention components

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Table 2. Univariate meta‐regression analyses for self‐reported depression diagnosis at the medium‐term assessment (targeted interventions)

	k	RR	(95% CI)	β	(95% CI)	P value (moderator)	Adjusted R² (%)	I² (Res) (%)	P value (overall)
Overall effect	22	0.82	(0.68 to 0.99)	‐0.20	(‐0.40 to 0.01)	0.06	0	37.0	0.04
Continuous
Intensity of intervention (hours)	21	—	—	‐0.02	(‐0.04 to 0.01)	0.08	92.0	0.9	0.08
Binary
Focus of intervention
CBT (reference)	17	0.81	(0.65 to 1.01)	—	—	—	0	44.9	0.95
CBT + IPT	2	0.44	(0.07 to 2.90)	‐0.03	(‐0.74 to 0.68)	0.93	—	—	—
IPT	2	0.53	(0.01 to 26.34)	‐0.39	(‐2.64 to 1.85)	0.72	—	—	—
Third wave	1	1.23	(0.19 to 8.15)	0.44	(‐1.71 to 2.59)	0.67	—	—	—
Depression severity at baseline
Subthreshold (reference)	10	1.01	(0.81 to 1.27)	—	—	—	99.0	0.5	0.02
Mild	8	0.57	(0.43 to 0.77)	‐0.52	(‐0.86 to ‐0.17)	0.01	—	—	—
Moderate	2	0.59	(0.40 to 0.88)	‐0.48	(‐0.93 to ‐0.03)	0.04	—	—	—
Severe	1	0.95	(0.65 to 1.37)	‐0.01	(‐0.44 to 0.41)	0.95	—	—	—
Focus of CBT (for CBT studies only)
CBT – cognitive and behavioural (reference)	9	0.87	(0.76 to 1.01)	—	—	—	0	41.8	0.62
CBT ‐ cognitive	10	0.83	(0.59 to 1.18)	0.10	(‐0.33 to 0.54)	0.62
CBT ‐ behavioural	0	—	—	—	—	—	—	—	—
Inclusion of relaxation component (for CBT studies only)
No mention of relaxation component (reference)	11	0.77	(0.63 to 0.95)	—	—	—	0	37.2	0.28
Relaxation component described as included	8	0.90	(0.65 to 1.24)	0.22	(‐0.20 to 0.63)	0.28	—	—	—
Inclusion of problem‐solving skills training component (for CBT studies only)
No mention of problem‐solving component (reference)	11	0.77	(0.55 to 1.08)	—	—	—	0	41.8	0.99
Problem‐solving component described as included	8	0.86	(0.74 to 1.01)	‐0.01	(‐0.43 to 0.43)	0.99	—	—	—
Inclusion of social skills training (for CBT studies only)
No mention of social skills component (reference)	9	0.70	(0.54 to 0.91)	—	—	—	11.0	32.9	0.13
Social skills component described as included	10	0.93	(0.73 to 1.18)	0.30	(‐0.09 to 0.70)	0.13	—	—	—
Type of facilitator
Mental health expert (reference group)	9	0.64	(0.45 to 0.90)	—	—	—	0	21.2	0.12
Students	8	0.89	(0.78 to 1.01)	0.18	(‐0.34 to 0.70)	0.48	—	—	—
Non‐mental health expert	5	1.05	(0.73 to 1.53)	0.49	(0.01 to 0.98)	0.05	—	—	—
Mode of delivery
Face‐to‐face (group or individual)	22	0.82	(0.68 to 0.99)	‐0.20	(‐0.40 to 0.01)	0.06	0	37.0	0.04
Online/telephone	0	—	—	—	—	—	—	—	—
k refers to number of trials. CBT: cognitive behavioural therapy CI: confidence interval IPT: interpersonal therapy

Table 2. Univariate meta‐regression analyses for self‐reported depression diagnosis at the medium‐term assessment (targeted interventions)

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Table 3. Univariate meta‐regression analyses for self‐reported depression scores at the post‐intervention assessment (targeted interventions)

	k	SMD	(95% CI)	β	(95% CI)	P value (moderator)	Adjusted R² (%)	I² (Res) (%)	P value (overall)
Overall effect	42	‐0.32	(‐0.42 to ‐0.23)	‐0.33	(‐0.44 to ‐0.22)	> 0.001	0	56.0	> 0.001
Continuous
Intensity of intervention (hours)	37	—	—	0.02	(‐0.01 to 0.03)	0.06	15.0	50.5	0.06
Binary
Focus of intervention
CBT (reference)	36	‐0.32	(‐0.42 to ‐0.22)	—	—	—	17.0	54.2	0.03
CBT + IPT	0	—	—	—	—	—	—	—	—
IPT	2	‐1.11	(‐1.89 to ‐0.33)	‐0.75	(‐1.35 to ‐0.15)	0.02	—	—	—
Third wave	4	‐0.10	(‐0.35 to 0.15)	0.21	(‐0.16 to 0.59)	0.26	—	—	—
Depression severity at baseline
Subthreshold (reference)	15	‐0.20	(‐0.33 to ‐0.07)	—	—	—	12.0	56.0	0.20
Mild	10	‐0.51	(‐0.69 to ‐0.33)	‐0.31	(‐0.60 to ‐0.02)	0.03	—	—	—
Moderate	10	‐0.41	(‐0.71 to ‐0.11)	‐0.14	(‐0.45 to 0.16)	0.35	—	—	—
Severe	4	‐0.31	(‐0.54 to ‐0.07)	‐0.12	(‐0.49 to 0.25)	0.52	—	—	—
Focus of CBT (for CBT studies only)
CBT – cognitive and behavioural (reference)	18	‐0.42	(‐0.58 to ‐0.27)	—	—	—	31.0	47.4	0.06
CBT ‐ cognitive	17	‐0.20	(‐0.30 to ‐0.10)	0.20	(‐0.01 to 0.40)	0.05	—	—	—
CBT ‐ behavioural	1	‐1.07	(‐1.91 to ‐0.23)	‐0.66	(‐1.68 to 0.37)	0.20	—	—	—
Inclusion of relaxation component (for CBT studies only)
No mention of relaxation component (reference)	17	‐0.30	(‐0.41 to‐0.91)	—	—	—	0	57.2	0.93
Relaxation component described as included	18	‐0.33	(‐0.50 to ‐0.17)	‐0.01	(‐0.24 to 0.22)	0.93	—	—	—
Inclusion of problem‐solving skills training component (for CBT studies only)
No mention of problem‐solving component (reference)	15	‐0.35	(‐0.49 to 0.20)	—	—	—	0	57.7	0.59
Problem‐solving component described as included	20	‐0.29	(‐0.43 to ‐0.15)	0.06	(‐0.17 to 0.29)	0.59	—	—	—
Inclusion of social skills training component (for CBT studies only)
No mention of social skills component (reference)	13	‐0.40	(‐0.54 to ‐0.27)	—	—	—	13.0	52.5	0.19
Social skills component described as included	22	‐0.26	(‐0.39 to ‐0.13)	0.15	(‐0.08 to 0.38)	0.19
Type of facilitator
Mental health expert (reference group)	20	‐0.39	(‐0.52 to ‐0.26)	—	—	—	30.0	43.5	0.08
Students	7	‐0.40	(‐0.62 to ‐0.19)	‐0.02	(‐0.29 to 0.24)	0.85	—	—	—
Non‐mental health expert	7	‐0.11	(‐0.21 to ‐0.01)	0.24	(0.02 to 0.46)	0.03	—	—	—
Mode of delivery
Face‐to‐face (group or individual) (reference group)	36	‐0.32	(‐0.42 to ‐0.23)	—	—	—	0	59.2	0.87
Online/telephone	6	‐0.45	(‐0.98 to ‐0.02)	‐0.03	(‐0.39 to 0.33)	0.87	—	—	—
k refers to number of trials. CBT: cognitive behavioural therapy CI: confidence interval IPT: interpersonal therapy

Table 3. Univariate meta‐regression analyses for self‐reported depression scores at the post‐intervention assessment (targeted interventions)

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Table 4. Univariate meta‐regression analyses for self‐reported depression diagnosis at the medium‐term assessment (universal interventions)

	k	RR	(95% CI)	β	(95% CI)	P value (moderator)	AdjustedR² (%)	I² (Res) (%)	P value (overall)
Overall effect	10	0.87	(0.66 – 1.14)	‐0.14	(‐0.45 to 0.17)	0.33	0	0	0.30
Continuous
Intensity of intervention (hours)	9	—	—	0.02	(‐0.04 to 0.08)	0.38	0	0	0.38
Binary
Focus of intervention
CBT (reference)	7	0.92	(0.64 to 1.31)	—	—	—	0	0	0.76
CBT + IPT	2	0.79	(0.38 to 1.64)	‐0.16	(‐1.13 to 0.80)	0.70	—	—	—
IPT	0
Third wave	1	0.72	(0.37 to 1.38)	‐0.26	(‐1.14 to 0.62)	0.51	—	—	—
Depression severity at baseline
Subthreshold (reference)	7	0.90	(0.65 to 1.23)	—	—	—	0	0	0.73
Mild	3	0.77	(0.37 to 1.58)	‐0.11	(‐0.81 to 0.59)	0.73	—	—	—
Moderate	0	—	—	—	—	—	—	—	—
Severe	0	—	—	—	—	—	—	—	—
Focus of CBT (for CBT studies only)
CBT – cognitive and behavioural (reference)	5	0.93	(0.67 to 1.30)	—	—	—	0	0	0.70
CBT ‐ cognitive	4	0.61	(0.23 to 1.64)	‐0.15	(‐1.03 to 0.73)	0.70	—	—	—
CBT ‐ behavioural	0	—	—	—	—	—	—	—	—
Inclusion of relaxation component (for CBT studies only)
No mention of relaxation component (reference)	4	0.93	(0.47 to 1.86)	—	—	—	0	0	0.87
Relaxation component described as included	5	0.89	(0.64 to 1.24)	‐0.06	(‐0.95 to 0.82)	0.87	—	—	—
Inclusion of problem‐solving skills training component (for CBT studies only)
No mention of problem‐solving component (reference)	2	0.26	(0.05 to 1.30)	—	—	—	0	0	0.17
Problem‐solving component described as included	7	0.94	(0.70 to 1.28)	1.27	(‐0.68 to 3.23)	0.17	—	—	—
Inclusion of social skills training component (for CBT studies only)
No mention of social skills component (reference)	4	0.91	(0.60 to 1.39)	—	—	—	0	0	0.85
Social skills component described as included	5	0.87	(0.53 to 1.43)	‐0.06	(‐0.81 to 0.68)	0.85	—	—	—
Type of facilitator
Mental health expert (reference group)	2	0.26	(0.05 to 1.30)	—	—	—	0	0	0.39
Students	3	0.68	(0.22 to 2.04)	0.97	(‐1.36 to 3.30)	0.35	—	—	—
Non‐mental health expert	4	0.90	(0.61 to 1.32)	1.22	(‐0.83 to 3.27)	0.19	—	—	—
Mode of delivery
Face‐to‐face (group or individual)	9	0.82	(0.57 to 1.16)	—	—	—	0	0	0.62
Online/telephone	1	0.94	(0.62 to 1.44)	0.15	(‐0.50 to 0.79)	0.62	—	—	—
k refers to number of trials. CBT: cognitive behavioural therapy CI: confidence interval IPT: interpersonal therapy

Table 4. Univariate meta‐regression analyses for self‐reported depression diagnosis at the medium‐term assessment (universal interventions)

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Table 5. Univariate meta‐regression analyses for self‐reported depression scores at the post‐intervention assessment (universal interventions)

	k	SMD	(95% CI)	β	(95% CI)	P value (moderator)	AdjustedR² (%)	I² (Res) (%)	P value (overall)
Overall effect	31	‐0.11	(‐0.17 to ‐0.05)	‐0.11	(‐0.17 to ‐0.04)	>0.001	0	41.0	> 0.001
Continuous
Intensity of intervention (hours)	29	—	—	0.01	(0.00 to 0.02)	> 0.001	68.0	18.0	> 0.001
Binary
Focus of intervention
CBT (reference)	21	‐0.11	(‐0.18 to ‐0.04)	—	—	—	0	46.5	0.79
CBT + IPT	3	‐0.08	(‐0.25 to 0.10)	0.02	(‐0.24 to 0.28)	0.87	—	—	—
IPT	1	‐0.27	(‐0.57 to 0.02)	‐0.16	(‐0.58 to 0.25)	0.43	—	—	—
Third wave	6	‐0.01	(‐0.31 to 0.30)	0.07	(‐0.19 to 0.33)	0.57	—	—	—
Depression severity at baseline
Subthreshold (reference)	25	‐0.11	(‐0.18 to ‐0.04)	—	—	—	0	45.9	0.62
Mild	5	‐0.06	(‐0.26 to 0.14)	0.05	(‐0.16 to 0.27)	0.62
Moderate	0	—	—	—	—	—	—	—	—
Severe	0	—	—	—	—	—	—	—	—
Focus of CBT (for CBT studies only)
CBT – cognitive and behavioural (reference)	11	‐0.08	(‐0.15 to ‐0.01)	—	—	—	2.0	42.7	0.42
CBT ‐ cognitive	13	‐0.14	(‐0.24 to ‐0.03)	‐0.05	(‐0.19 to 0.08)	0.42
CBT ‐ behavioural	0	—	—	—	—	—	—	—	—
Inclusion of relaxation component (for CBT studies only)
No mention of relaxation component (reference)	11	‐0.13	(‐0.23 to ‐0.04)	—	—	—	9.0	40.8	0.45
Relaxation component described as included	13	‐0.08	(‐0.16 to ‐0.01)	0.05	(‐0.09 to 0.19)	0.45	—	—	—
Inclusion of problem‐solving skills training component (for CBT studies only)
No mention of problem‐solving component (reference)	6	‐0.20	(‐0.34 to ‐0.07)	—	—	—	14.0	40.4	0.13
Problem‐solving component described as included	18	‐0.08	(‐0.15 to ‐0.01)	0.12	(‐0.04 to 0.28)	0.13	—	—	—
Inclusion of social skills training component (for CBT studies only)
No mention of social skills component (reference)	8	‐0.18	(‐0.29 to ‐0.07)	—	—	—	13.0	39.5	0.11
Social skills component described as included	16	‐0.06	(‐0.13 to 0.01)	0.11	(‐0.03 to 0.24)	0.11
Type of facilitator
Mental health expert (reference group)	11	‐0.11	(‐0.23 to 0.02)	—	—	—	0	48.0	0.57
Students	6	‐0.21	(‐0.38 to ‐0.05)	‐0.10	(‐0.35 to 0.14)	0.38	—	—	—
Non‐mental health expert	8	‐0.09	(‐0.22 to 0.03)	0.01	(‐0.19 to 0.22)	0.88	—	—	—
Mode of delivery
Face‐to‐face (group or individual)	27	‐0.11	(‐0.19 to ‐0.04)	—	—	—	0	43.9	0.76
Online/telephone	4	‐0.07	(‐0.18 to 0.03)	0.03	(‐0.15 to 0.20)	0.76	—	—	—
k refers to number of trials. CBT: cognitive behavioural therapy CI: confidence interval IPT: interpersonal therapy

Table 5. Univariate meta‐regression analyses for self‐reported depression scores at the post‐intervention assessment (universal interventions)

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Comparison 1. Psychological intervention versus any comparison

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depressive diagnosis (by population) post‐intervention Show forest plot	20	3232	Risk Difference (M‐H, Random, 95% CI)	‐0.05 [‐0.08, ‐0.02]

1.1 Targeted	13	2022	Risk Difference (M‐H, Random, 95% CI)	‐0.06 [‐0.10, ‐0.02]
1.2 Universal	7	1210	Risk Difference (M‐H, Random, 95% CI)	‐0.04 [‐0.08, 0.00]
2 Depressive diagnosis short‐term follow‐up Show forest plot	6	724	Risk Difference (M‐H, Random, 95% CI)	‐0.04 [‐0.11, 0.03]

2.1 Targeted	4	360	Risk Difference (M‐H, Random, 95% CI)	‐0.11 [‐0.19, ‐0.02]
2.2 Universal	2	364	Risk Difference (M‐H, Random, 95% CI)	0.03 [‐0.04, 0.10]
3 Depressive diagnosis medium‐term follow‐up Show forest plot	32	5965	Risk Difference (M‐H, Random, 95% CI)	‐0.03 [‐0.05, ‐0.01]

3.1 Targeted	22	3915	Risk Difference (M‐H, Random, 95% CI)	‐0.04 [‐0.07, ‐0.01]
3.2 Universal	10	2050	Risk Difference (M‐H, Random, 95% CI)	‐0.01 [‐0.03, 0.01]
4 Depressive diagnosis long‐term follow‐up Show forest plot	10	1769	Risk Difference (M‐H, Random, 95% CI)	‐0.02 [‐0.05, 0.02]

4.1 Targeted	6	1043	Risk Difference (M‐H, Random, 95% CI)	‐0.03 [‐0.09, 0.03]
4.2 Universal	4	726	Risk Difference (M‐H, Random, 95% CI)	‐0.01 [‐0.03, 0.02]
5 Depression symptoms (by population) post‐intervention Show forest plot	73	13829	Std. Mean Difference (IV, Random, 95% CI)	‐0.21 [‐0.27, ‐0.15]

5.1 Targeted	42	4816	Std. Mean Difference (IV, Random, 95% CI)	‐0.32 [‐0.42, ‐0.23]
5.2 Universal	31	9013	Std. Mean Difference (IV, Random, 95% CI)	‐0.11 [‐0.17, ‐0.05]
6 Depression symptoms short‐term follow‐up Show forest plot	16	1558	Std. Mean Difference (IV, Random, 95% CI)	‐0.31 [‐0.45, ‐0.17]

6.1 Targeted	11	999	Std. Mean Difference (IV, Random, 95% CI)	‐0.37 [‐0.54, ‐0.20]
6.2 Universal	5	559	Std. Mean Difference (IV, Random, 95% CI)	‐0.18 [‐0.37, 0.01]
7 Depression symptoms medium‐term follow‐up Show forest plot	53	11913	Std. Mean Difference (IV, Random, 95% CI)	‐0.12 [‐0.18, ‐0.05]

7.1 Targeted	29	4448	Std. Mean Difference (IV, Random, 95% CI)	‐0.23 [‐0.33, ‐0.12]
7.2 Universal	24	7465	Std. Mean Difference (IV, Random, 95% CI)	‐0.02 [‐0.08, 0.03]
8 Depression symptoms long‐term follow‐up Show forest plot	15	3836	Std. Mean Difference (IV, Random, 95% CI)	0.00 [‐0.06, 0.06]

8.1 Targeted	7	847	Std. Mean Difference (IV, Random, 95% CI)	‐0.05 [‐0.21, 0.11]
8.2 Universal	8	2989	Std. Mean Difference (IV, Random, 95% CI)	0.02 [‐0.06, 0.09]
9 Depression symptoms clinician‐rated (by population) post‐intervention Show forest plot	11	2175	Std. Mean Difference (IV, Random, 95% CI)	‐0.23 [‐0.41, ‐0.05]

9.1 Targeted	10	1340	Std. Mean Difference (IV, Random, 95% CI)	‐0.28 [‐0.44, ‐0.11]
9.2 Universal	1	835	Std. Mean Difference (IV, Random, 95% CI)	0.07 [‐0.06, 0.21]
10 Depression symptoms clinician‐rated medium‐term follow‐up Show forest plot	9	1754	Std. Mean Difference (IV, Random, 95% CI)	‐0.08 [‐0.24, 0.07]

10.1 Targeted	8	968	Std. Mean Difference (IV, Random, 95% CI)	‐0.10 [‐0.30, 0.09]
10.2 Universal	1	786	Std. Mean Difference (IV, Random, 95% CI)	0.00 [‐0.14, 0.14]
11 Depression symptoms clinician‐rated long‐term follow‐up Show forest plot	6	894	Std. Mean Difference (IV, Random, 95% CI)	‐0.12 [‐0.25, 0.01]

11.1 Targeted	6	894	Std. Mean Difference (IV, Random, 95% CI)	‐0.12 [‐0.25, 0.01]
12 Anxiety symptoms (by population) post‐intervention Show forest plot	23	5017	Std. Mean Difference (IV, Random, 95% CI)	‐0.07 [‐0.16, 0.02]

12.1 Targeted	13	1666	Std. Mean Difference (IV, Random, 95% CI)	‐0.13 [‐0.31, 0.04]
12.2 Universal	10	3351	Std. Mean Difference (IV, Random, 95% CI)	‐0.04 [‐0.13, 0.05]
13 Anxiety symptoms (by population) short‐term follow‐up Show forest plot	3	334	Std. Mean Difference (IV, Random, 95% CI)	‐0.33 [‐0.59, ‐0.07]

13.1 Targeted	3	334	Std. Mean Difference (IV, Random, 95% CI)	‐0.33 [‐0.59, ‐0.07]
14 Anxiety symptoms (by population) medium‐term follow‐up Show forest plot	18	4957	Std. Mean Difference (IV, Random, 95% CI)	‐0.08 [‐0.14, ‐0.01]

14.1 Targeted	10	1827	Std. Mean Difference (IV, Random, 95% CI)	‐0.07 [‐0.18, 0.04]
14.2 Universal	8	3130	Std. Mean Difference (IV, Random, 95% CI)	‐0.09 [‐0.17, ‐0.01]
15 Anxiety symptoms (by population) long‐term follow‐up Show forest plot	5	971	Std. Mean Difference (IV, Random, 95% CI)	‐0.15 [‐0.44, 0.14]

15.1 Targeted	2	293	Std. Mean Difference (IV, Random, 95% CI)	‐0.20 [‐0.43, 0.03]
15.2 Universal	3	678	Std. Mean Difference (IV, Random, 95% CI)	‐0.11 [‐0.61, 0.40]
16 Social and general functioning (by population) post‐intervention Show forest plot	10	2067	Std. Mean Difference (IV, Random, 95% CI)	0.24 [0.06, 0.41]

16.1 Targeted	9	1021	Std. Mean Difference (IV, Random, 95% CI)	0.27 [0.04, 0.50]
16.2 Universal	1	1046	Std. Mean Difference (IV, Random, 95% CI)	0.16 [0.04, 0.28]
17 Social and general functioning (by population) short‐term follow‐up Show forest plot	1	40	Std. Mean Difference (IV, Random, 95% CI)	0.81 [0.12, 1.49]

17.1 Targeted	1	40	Std. Mean Difference (IV, Random, 95% CI)	0.81 [0.12, 1.49]
17.2 Universal	0	0	Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
18 Social and general functioning (by population) medium‐term follow‐up Show forest plot	11	2449	Std. Mean Difference (IV, Random, 95% CI)	0.15 [0.02, 0.28]

18.1 Targeted	9	1058	Std. Mean Difference (IV, Random, 95% CI)	0.19 [0.00, 0.38]
18.2 Universal	2	1391	Std. Mean Difference (IV, Random, 95% CI)	0.09 [‐0.01, 0.20]
19 Social and general functioning (by population) long‐term follow‐up Show forest plot	4	744	Std. Mean Difference (IV, Random, 95% CI)	‐0.01 [‐0.16, 0.14]

19.1 Targeted	3	342	Std. Mean Difference (IV, Random, 95% CI)	‐0.01 [‐0.22, 0.21]
19.2 Universal	1	402	Std. Mean Difference (IV, Random, 95% CI)	‐0.01 [‐0.21, 0.19]

Comparison 1. Psychological intervention versus any comparison

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Comparison 2. Psychological intervention versus any comparison for targeted interventions

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depressive diagnosis medium‐term follow‐up Show forest plot	22	3915	Risk Difference (M‐H, Random, 95% CI)	‐0.04 [‐0.07, ‐0.01]

1.1 Treatment as usual	12	2464	Risk Difference (M‐H, Random, 95% CI)	‐0.04 [‐0.09, 0.01]
1.2 No treatment	8	1286	Risk Difference (M‐H, Random, 95% CI)	‐0.03 [‐0.08, 0.01]
1.3 Wait‐list	1	95	Risk Difference (M‐H, Random, 95% CI)	‐0.08 [‐0.21, 0.05]
1.4 Other	1	70	Risk Difference (M‐H, Random, 95% CI)	‐0.12 [‐0.29, 0.04]
2 Depression symptoms post‐intervention Show forest plot	42	4816	Std. Mean Difference (IV, Random, 95% CI)	‐0.32 [‐0.42, ‐0.23]

2.1 Treatment as usual	16	2514	Std. Mean Difference (IV, Random, 95% CI)	‐0.30 [‐0.45, ‐0.15]
2.2 No treatment	14	1274	Std. Mean Difference (IV, Random, 95% CI)	‐0.39 [‐0.57, ‐0.21]
2.3 Attention placebo	4	466	Std. Mean Difference (IV, Random, 95% CI)	‐0.10 [‐0.32, 0.13]
2.4 Wait‐list	6	361	Std. Mean Difference (IV, Random, 95% CI)	‐0.49 [‐0.72, ‐0.26]
2.5 Other	2	201	Std. Mean Difference (IV, Random, 95% CI)	‐0.24 [‐0.51, 0.04]
3 Depression symptoms medium‐term follow‐up Show forest plot	29	4448	Std. Mean Difference (IV, Random, 95% CI)	‐0.23 [‐0.33, ‐0.12]

3.1 Treatment as usual	15	2315	Std. Mean Difference (IV, Random, 95% CI)	‐0.28 [‐0.42, ‐0.13]
3.2 No treatment	9	1207	Std. Mean Difference (IV, Random, 95% CI)	‐0.10 [‐0.30, 0.09]
3.3 Attention placebo	3	761	Std. Mean Difference (IV, Random, 95% CI)	‐0.11 [‐0.26, 0.03]
3.4 Wait‐list	1	95	Std. Mean Difference (IV, Random, 95% CI)	‐0.13 [‐0.55, 0.28]
3.5 Other	1	70	Std. Mean Difference (IV, Random, 95% CI)	‐1.14 [‐1.64, ‐0.63]

Comparison 2. Psychological intervention versus any comparison for targeted interventions

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Comparison 3. Psychological intervention versus any comparison for universal interventions

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depressive diagnosis medium‐term follow‐up Show forest plot	10	2050	Risk Difference (M‐H, Random, 95% CI)	‐0.01 [‐0.03, 0.01]

1.1 Treatment as usual	3	656	Risk Difference (M‐H, Random, 95% CI)	‐0.05 [‐0.17, 0.07]
1.2 No treatment	2	316	Risk Difference (M‐H, Random, 95% CI)	0.01 [‐0.05, 0.07]
1.3 Attention placebo	2	861	Risk Difference (M‐H, Random, 95% CI)	‐0.00 [‐0.04, 0.04]
1.4 Wait‐list	3	217	Risk Difference (M‐H, Random, 95% CI)	‐0.08 [‐0.24, 0.09]
2 Depression symptoms post‐intervention Show forest plot	31	9013	Std. Mean Difference (IV, Random, 95% CI)	‐0.11 [‐0.17, ‐0.05]

2.1 Treatment as usual	9	1791	Std. Mean Difference (IV, Random, 95% CI)	‐0.15 [‐0.31, 0.00]
2.2 No treatment	9	4231	Std. Mean Difference (IV, Random, 95% CI)	‐0.15 [‐0.25, ‐0.05]
2.3 Attention placebo	9	2180	Std. Mean Difference (IV, Random, 95% CI)	‐0.00 [‐0.09, 0.08]
2.4 Wait‐list	4	811	Std. Mean Difference (IV, Random, 95% CI)	‐0.12 [‐0.28, 0.04]
3 Depression symptoms medium‐term follow‐up Show forest plot	24	7465	Std. Mean Difference (IV, Random, 95% CI)	‐0.02 [‐0.08, 0.03]

3.1 No treatment	7	3367	Std. Mean Difference (IV, Random, 95% CI)	0.03 [‐0.10, 0.16]
3.2 Treatment as usual	6	1505	Std. Mean Difference (IV, Random, 95% CI)	‐0.05 [‐0.16, 0.05]
3.3 Attention placebo	7	1813	Std. Mean Difference (IV, Random, 95% CI)	‐0.01 [‐0.10, 0.09]
3.4 Wait‐list	4	780	Std. Mean Difference (IV, Random, 95% CI)	‐0.13 [‐0.34, 0.07]
3.5 Other	0	0	Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 3. Psychological intervention versus any comparison for universal interventions

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Comparison 4. Psychological intervention versus any comparison for selected and indicated interventions

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depressive diagnosis medium‐term follow‐up Show forest plot	22	3915	Risk Difference (M‐H, Random, 95% CI)	‐0.04 [‐0.07, ‐0.01]

1.1 Selective	3	963	Risk Difference (M‐H, Random, 95% CI)	0.02 [‐0.07, 0.12]
1.2 Indicated	16	2374	Risk Difference (M‐H, Random, 95% CI)	‐0.03 [‐0.06, ‐0.01]
1.3 Combined	3	578	Risk Difference (M‐H, Random, 95% CI)	‐0.14 [‐0.21, ‐0.07]
2 Depression symptoms (by population) post‐intervention Show forest plot	42	4816	Std. Mean Difference (IV, Random, 95% CI)	‐0.32 [‐0.42, ‐0.23]

2.1 Selective	9	1394	Std. Mean Difference (IV, Random, 95% CI)	‐0.16 [‐0.30, ‐0.02]
2.2 Indicated	29	2740	Std. Mean Difference (IV, Random, 95% CI)	‐0.37 [‐0.50, ‐0.24]
2.3 Combined	4	682	Std. Mean Difference (IV, Random, 95% CI)	‐0.30 [‐0.45, ‐0.15]

Comparison 4. Psychological intervention versus any comparison for selected and indicated interventions

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Comparison 5. Self‐reported depression symptoms versus clinician‐rated depression symptoms

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Depression scores (by assessor) post‐intervention Show forest plot	9		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 Self‐reported	9	1877	Std. Mean Difference (IV, Random, 95% CI)	‐0.32 [‐0.53, ‐0.12]
1.2 Clinician‐rated	9	1884	Std. Mean Difference (IV, Random, 95% CI)	‐0.25 [‐0.46, ‐0.04]
2 Depression scores medium‐term follow‐up Show forest plot	7		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Self‐reported	7	1465	Std. Mean Difference (IV, Random, 95% CI)	‐0.21 [‐0.41, ‐0.02]
2.2 Clinician‐rated	7	1468	Std. Mean Difference (IV, Random, 95% CI)	‐0.13 [‐0.32, 0.06]
3 Depression scores long‐term follow‐up Show forest plot	4		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

3.1 Self‐reported	4	390	Std. Mean Difference (IV, Random, 95% CI)	‐0.11 [‐0.37, 0.16]
3.2 Clinician‐rated	4	388	Std. Mean Difference (IV, Random, 95% CI)	‐0.06 [‐0.27, 0.14]

Comparison 5. Self‐reported depression symptoms versus clinician‐rated depression symptoms

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