Most researchers and practitioners define prevention as intervention approaches that are provided before people meet the formal criteria of a depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). There are three types of prevention: universal, selective and indicated prevention.
Acute and maintenance treatment are aimed at people who have established disorders meeting diagnostic criteria. In contrast, there are three types of prevention:
- universal prevention, which is aimed at the general population or parts of the general population, regardless of whether individuals have a higher than average risk of developing a disorder (e.g. school programs or mass media campaigns);
- selective prevention, which is aimed at high-risk groups who have not yet developed a mental disorder; and
- indicated prevention, which is aimed at individuals who have some symptoms of a mental disorder but do not meet diagnostic criteria.
Risk Factors
Following the National Research Council and Institute of Medicine's 2009 Report on Preventing Mental, Emotional and Behavioral Disorders Among Young People, Muñoz, Beardslee and Yelkin identify two broad classes of risk factors for depression (Muñoz, Beardslee & Yelkin, 2012):
- Specific risk factors are rather proximate, individual characteristics of an individual and its environment that increase the hazard of depressive episodes occurring eventually. Such factors include having first-degree relatives with a history of depression, having high symptoms of depression that do not yet mount up to fulfil the criteria for a clinical diagnosis, and exhibiting dysfunctional behavioural patterns or thought schemata. Since having experienced a depressive episode already constitutes a considerable statistical risk for developing a subsequent episode, much emphasis should be put on preventing first occurences of major depression.
- Unspecific risk factors are generic, distant factors which lead to higher rates of depression and associated illnesses in affected individuals. Poverty, for example, may result in a variety of poor outcomes in children, including an elevated risk for depression (Aber, Yoshikawa & Beardslee, 2012; Gilman, Kawachi, Fitzmaurice & Buka, 2003). Having been exposed to violence or abuse in childhood is similarly associated with anxiety, posttraumatic stress disorder, and depression in adulthood.
Overall, most prevention and health promotion researchers argue that not one factor alone is capable of predicting mental health outcomes in the broader scheme. The biopsychosocial model illustrates that social, cognitive/psychological, and biological factors inform each other and cumulatively influence the risk of depression.
