Abstract
The prevention of major depression is an important research goal which deserves increased attention. Depressive symptoms and disorders are particularly common in primary care patients and have a negative impact on functioning and well-being comparable with other major chronic medical conditions. The San Francisco Depression Prevention Research project conducted a randomized, controlled, prevention trial to demonstrate the feasibility of implementing such research in a public sector setting serving low-income, predominantly minority individuals: 150 primary care patients free from depression or other major mental disorders were randomized to an experimental cognitive-behavioral intervention or to a control condition. The experimental intervention group reported a significantly greater reduction in depressive levels. Decline in depressive levels was significantly mediated by decline in the frequency of negative conditions. Group differences in the number of new episodes (incidence) of major depression did not reach significance during the 1-year trial. We conclude that depression prevention trials in public sector primary care settings are feasbile, and that depressive symptoms can be reduced even in low-income, minority populations. To conduct randomized prevention trials that can test effects on incidence with sufficient statistical power, subgroups at greater imminent risk have to be identified.
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Azocar, F., Areán, P., Miranda, J., & Muñoz, R. (1993, July).The Spanish translation of the Beck Depression Inventory: An item bias analysis. Paper presented at the meeting of the Interamerican Congress of Psychology, Santiago, Chile.
Bandura, A. (1977).Social learning theory. Englewood Cliffs, NJ: Prentice-Hall.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations.Journal of Personality and Social Psychology, 51 1173–1182.
Beck, A. T., Ward, C. H., Mendelsohn, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression.Archives of General Psychiatry, 4, 561–571.
Boyd, J. H., & Weissman, M. M. (1982). Epidemiology. In E. S. Paykel (Ed.),Handbook of affective disorders (pp. 109–125). New York: Guilford.
Bruce, M. L., Takeuchi, D. T., & Leaf, P. J. (1991). Poverty and psychiatric status: Longitudinal evidence from the New Haven Epidemiologic Catchment Area Study.Archives of General Psychiatry, 48, 470–474.
Chan, F., Ying, Y. W., & Muñoz, R. F. (1986). The Depression Prevention Research project: The Chinese study.Asian American Psychological Association Journal, 1, 1–4.
Clarke, G., Hawkins, W., Murphy, M., Sheeber, L., Lewinsohn, P. M., & Seeley, J. R. (1995). Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: A randomized trial of a group cognitive intervention.Journal of the American Academy of Child and Adolescent Psychiatry, 34, 312–321.
Depression Guideline Panel. (1993).Depression in primary care: Detection, diagnosis, and treatment. Quick Reference Guide for Clinicians, No. 5 (AHCPR Publication No. 93-0552). Rockville, MD: U.S. Public Health Service, Agency for Health Care Policy and Research.
DiMascio, A., Weissman, M. M., Prusoff, B. A., Neu, C., Zwilling, M., & Klerman, G. L. (1979). Differential symptom reduction by drugs and psychotherapy in acute depression.Archives of General Psychiatry, 36, 1450–1456.
Dryman, A., & Eaton, W. W. (1991). Affective symptoms associated with the onset of major depression in the community: Findings from the U.S. National Institute of Mental health Epidemiological Catchment Area Program.Acta Psychiatrica Scandinavica, 84, 1–5.
Eaton, W. W., Kramer, M., Anthony, J. C., Dryman, A., Shapiro, S., & Locke, B. Z. (1989). The incidence of specific DIS/DSM-III mental disorders: Data from the NIMH Epidemiological Catchment Area Program.Acta Psychiatrica Scandinavica, 79, 163–178.
Ellis, A. (1962).Reason and emotion in psychotherapy. New York: Stewart.
Ellis, A., & Harper, R. A. (1961).A guide to rational living. Hollywood, CA: Wilshire.
Gross, J. J., & Muñoz, R. F. (in press). Emotion regulation and mental health.Clinical psychology: Science and Practice.
Hartman, B. J. (1968). Sixty revealing questions for twenty minutes.rational Living, 3, 7–8.
Hoeper, E. W., Nycz, G. R., Cleary, P. D., Regier, D. A., & Goldberg, I. D. (1979). Estimated prevalence of RDC mental disorder in primary medical care.International Journal of Mental Health, 8, 6–15.
Hollon, S., DeRubeis, R., & Seligman, M. (1992). Cognitive therapy and the prevention of depression.Applied and Preventive Psychology, 1, 89–95.
Horwath, E., Johnson, J., Klerman, G. L., & Weissman, M. M. (1992) Depressive symptoms as relative and attributable risk factors for first-onset major depression.Archives of General Psychiatry, 49, 817–823.
Hulley, S. B., & Cummings, S. R. (Eds.). (1988).Designing clinical research (Table 13B). Baltimore, MD: Williams & Wilkins.
Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., Wittchen, H. U., & Kendler, K. S. (1994). Lifetime and 12-month prevalence of DMS-III-R psychiatric disorder in the United States: Results from the National Comorbidity Survey.Archives of General Psychiatry, 51, 8–19.
Klerman, G. L., & Weissman, M. M. (1989). Increasing rates of depression.Journal of the American Medical Association, 261, 2229–2235.
Lewinsohn, P. M., Biglan, A., & Zeiss, A. M. (1976). Behavioral treatment of depression. In P. O. Davidson (Eds.),The behavioral management of anxiety, depression and pain (pp. 91–146). New York: Brunner/Mazel.
Lewinsohn, P. M., Muñoz, R. F., Youngren, M. A., & Zeiss, A. M. (1986).Control your depression (Rev. ed.) New York: Prentice-Hall.
Lowry, M. R. (1984).Major depression: Prevention and treatment. St. Louis, MO: Warren H. Green.
Maccoby, N., & Alexander, J. (1979). Reducing heart disease risk using the mass media: Comparing the effects on three communities. In R. F. Muñoz, L. R. Snowden, & J. G. Kelly (Eds.),Social and psychological research in community settings. San Francisco: Jossey-Bass.
MacPhillamy, D. J., & Lewinsohn, P. M. (1971).The Pleasant Events Schedule. Unpublished manuscript, University of Oregon, Eugene.
McLean, P. D., & Hakstian, A. R. (1979). Clinical depression: Comparative efficacy of outpatient treatments.Journal of Consulting and Clinical Psychology, 47, 818–836.
Miranda, J., & Muñoz, R. F. (1994). Intervention for minor depression in primary care patients.Psychosomatic Medicine, 56, 136–142.
Miranda, J., Muñoz, R. F., & Shumway, M. (1990). Depression prevention research: The need for screening scales that truly predict. In C. C. Attkisson & J. M. Zich (Eds.),Depression in primary care: Screening and detection (pp. 232–250). New York: Routledge.
Mrazek, P., & haggerty, R. (Eds.). (1994).Reducing risks for mental disorders: Frontiers for preventive intervention research. Washington, DC: National Academy Press.
Muñoz, R. F. (1977). A cognitive approach to the assessment and treatment of depression.Dissertation Abstracts International, 38, 2873B.
Muñoz, R. F. (1986). Opportunities for prevention among Hispanics. In R. L. Hough, P. A. Gongla, V. B. Brown, & S. E. Goldston (Eds.),Psychiatric epidemiology and prevention: The possibilities (pp. 109–129). Los Angeles: University of California Neuropsychiatric Institute.
Muñoz, R. F. (1987). The future of depression prevention research. In R. F. Muñoz (Ed.),Depression prevention: Research directions (pp. 281–293). Washington, DC: Hemisphere.
Muñoz, R. F. (1993). The prevention of depression: Current research and practice.Applied and Preventive Psychology, 2, 21–33.
Muñoz, R. F., Chan, F., & Armas, R. (1986). Cross-cultural perspectives on primary prevention of mental disorders. In J. T. Barter & S. W. Talbott (Eds.),Primary prevention in psychiatry: State of the art (pp. 15–54). Washington, DC: American Psychiatric Press.
Muñoz, R. F., Glish, M., Soo-Hoo, T., & Robertson, J. L. (1982). The San Francisco Mood Survey project: Preliminary work toward the prevention of depression.American Journal of Community Psychology, 10, 317–329.
Muñoz, R. F., González, G. M., & Starkweather, J. (1995). Automated screening for depression: Toward culturally and linguistically approapriate uses of computerized speech recognition.Hispnic Journal of Behavioral Sciences, 17, 194–208.
Muñoz, R. F., Hollon, S. D., McGrath, E., Rehm, L. P., & VandenBos, G. R. (1994). On the AHCPR Depression in Primary Care guidelines: Further considerations for practitioners.American Psychologist, 49, 42–61.
Muñoz, R. F., & Ying, Y. (1993).The prevention of depression: Research and practice. Baltimore, MD: Johns Hopkins University Press.
Muñoz, R. F., Ying, Y., Armas, R., Chan, F., & Gurza, R. (1987). The San Francisco Depression Prevention Research Project: A randomized trial with medical outpatients. In R. F. Muñoz (Ed.),Depression prevention: Research directions (pp. 199–215). Washington, DC: Hemisphere.
Murphy, G. E., Simons, A. D., Wetzel, R. D., & Lustman, P. J. (1984). Cognitive therapy and pharmacotherapy: Singly and together in the treatment of depression.Archives of General Psychiatry, 41, 33–41.
Myers, J. K., Weissman, M. M., Tischler, G. L., Holzer, C. E., Leaf, P. J., Orvaschel, H., Anthony, J. C., Boyd, J. H., Burke, J. D., Kramer, J., & Stolzman, R. (1984). Six-month prevalence of psychiatric disorders in three communities.Archives of General Psychiatry, 41, 959–967.
Nietzel, M. T., Russell, R. L., Hemmings, K. A., & Gretter, M. L. (1987). Clinical significance of psychotherapy for unipolar depression: A meta-analytic approach to social comparison.Journal of Consulting and Clinical Psychology, 55, 156–161.
Post, R. M., Rubinow, D. R., & Ballenger, J. C. (1984). Conditioning, sensitization, and kindling: Implications for the course of affective illness. In R. M. Post & J. C. Ballenger (Eds.),Neurobiology of mood disorders (pp. 432–466). Baltimore, MD: Williams & Wilkins.
Price, R. H., van Ryn, M., & Vinokur, A. (1992). Impact of a preventive job search intervention on the likelihood of depression among the unemployed.Journal of Health and Social Behavior, 33, 158–167.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population.Applied Psychological Measurement, 1, 385–401.
Roberts, R. E. (1987). Epidemiological issues in measuring preventive effects. In R. F. Muñoz (Ed.),Depression prevention: Research directions (pp. 45–75). Washington, DC: Hemisphere.
Robins, L. N., Helzer, J. E., Croughan, J., & Ratcliff, K. S. (1981). National Institute of Mental Health Diagnostic Interview Schedule: Its history, characteristics, and validity.Archives of General Psychiatry, 38, 381–389.
Rush, A. J., Beck, A. T., Kovacs, M., & Hollon, S. (1977). Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients.Cognitive Therapy and Research, 1, 17–37.
Sayetta, R. B., & Johnson, D. P. (1980). Basic data on depressive symptomatology: United States, 1974–75,Vital and Health Statistics (Series 11, No. 216, DHEW Publication No. PHS 80-1666). Hyatsville, MD: National Center for Health Statistics.
Shapiro, S., Skinner, E. A., Kessler, L. G., Von Korff, M., German, P. S., Tischler, G. L., Leaf, P. J., Benham, L., Cottler, L., & Regier, D. A. (1984). Utilization of health and mental health services: Three Epidemiological Catchment Area sites.Archives of General Psychiatry, 41, 971–978.
Simons, A. D., Levine, J. L., Lustman, P. J., & Murphy, E. E. (1984). Patient attrition in a comparative outcome study of depression: A follow-up report.Journal of Affective Disorders, 6, 163–173.
Simons, A. D., Murphy, G. E., Levine, J. L., & Wetzel, R. D. (1986). Cognitive therapy and pharmacotherapy for depression: Sustained improvement over one year.Archives of General Psychiatry, 43, 43–48.
Steinbrueck, S. M., Maxwell, S. E., & Howard, G. S. (1983). a meta-analysis of psychotherapy and drug therapy in the treatment of unipolar depression with adults.Journal of Consulting and Clinical Psychology, 51, 856–863.
Vega, A. W., & Rumbaut, R. G. (1991). Ethnic minorities and mental health.Annual Review of Sociology, 17, 351–383.
Weissman, M. M., Jarrett, R. B., & Rush, J. A. (1987). Psychotherapy and its relevance to the pharmacotherapy of major depression: A decade later (1976–1985). In H. Y. Meltzer (Ed.),Psychopharmacology: The third generation of progress (pp. 1059–1069). New York: Raven.
Wells, K. B., Stewart, A., Hays, R. D., Burnam, M. A., Rogers, W., Daniels, M., Berry, S., Greenfield, S., & Ware, J. (1989). The functioning and well-being of depressed patients: Results from the Medical Outcomes Study.Journal of the American Medical Association, 262, 914–919.
Youngren, M. A. (1978).The functional relationship of depression and problematic interpersonal behavior. Unpublished doctoral dissertation, University of Oregon, Eugene.
Youngren, M. A., Zeiss, A. M., & Lewinsohn, P. M. (1975).The interpersonal events schedule. Unpublished manuscript, University of Oregon, Eugene.
Zeiss, A. M., Lewinsohn, P. M., & Muñoz, R. F. (1979). Nonspecific improvement effects in depression using interpersonal skills training, pleasant activity schedules, or cognitive training.Journal of Consulting and Clinical Psychology, 47, 427–439.
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This study was supported in part by a grant (MH37992) from the National Institute of Mental Health (Muñoz, P. I.). Xiulan Zhang, Florentius Chan, and Martha Shumway assisted with the analyses. Regina Armas coordinated administration of the Diagnostic Interview Schedule. Steve Batki, James Dilley, and Roberto Gurza conducted pilot studies for this project. Ana Isabel Alvarez was one of the Spaish language instructors for the current study. We gratefully acknowledge the cooperation of the patients and personnel of the San Francisco General Hospital General Medicine Clinic (Richard Fine, Director), Family Health Clinic (Robert Drickey and Joyce Bradey, former Directors), and The University of California General Medicine Practice (Albert Martin, former Director). Manuscript preparation was supported in part by a University of California SCR43 Program Development Grant for the University of California, San Francisco/San Francisco General Hospital latino Task Force's Latino Mental Health Research Program. We thank Sonia Gálvez for her assistance in this task. Muñoz, Sorensen, Hargreaves, and Miranda are in the Department of Psychiatry and Pérez-Stable in the Department of Medicine at the University of California, San Francisco. Ying and Miller are at the School of Social Welfare, University of California, Berkeley. Bernal is in the Department of Psychology, University of Puerto Rico.
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Muñoz, R.F., Ying, YW., Bernal, G. et al. Prevention of depression with primary care patients: A randomized controlled trial. Am J Commun Psychol 23, 199–222 (1995). https://doi.org/10.1007/BF02506936
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DOI: https://doi.org/10.1007/BF02506936