Prevention is defined as “interventions that occur before the initial onset of a disorder to prevent the development of disorder” (Mrazek & Haggerty, 1994, p. 23).
The prevention of depression relies on reducing the risk factors for mental disorder, as well as enhancing the protective factors that promote mental health. The level of risk of an individual developing depression can be determined by their exposure and vulnerability to risk factors and the presence and strength of protective factors associated with its development.
Prevention interventions can be targeted universally (primary prevention) at the general population, selectively at population subgroups or individuals whose risk of developing depression is significantly higher than average, or as indicated by the needs of high-risk individuals, such as those with the early signs and symptoms of depression.
Universal (Primary) Prevention: Interventions that are directed towards whole populations and that have not been identified on the basis of risk and are aimed at improving the overall mental health of a population. An example is building connectedness and a sense of belonging, coping skills and hope for the future in school students.
Working with a community to reduce risk factors associated with depression, such as low control and high stress levels in a workplace community, is also a universal prevention.
Selective (Secondary) Prevention: It focuses on population groups and individuals at higher risk of depression. The level of risk is identified as being significantly higher than average and may be an imminent or a lifetime risk. Selective prevention interventions aim to reduce the risks to the targeted population.
Examples are positive parenting programs in disadvantaged populations, school-based programs specifically targeting young people at risk of depression, and programs for people exposed and at risk following adverse life experiences, such as divorce or bereavement.
Early Intervention: Indicated prevention is aimed at population groups and individuals at high risk of the onset of a disorder, who have the early signs and symptoms foreshadowing depression but who do not meet the diagnostic criteria for diagnosis of a disorder.
Early intervention refers to interventions targeting people displaying the early signs and symptoms of a mental health problem or mental disorder and people developing or experiencing a first episode of mental disorder. Early intervention encompasses ‘indicated prevention’, ‘case identification’ and ‘early treatment’.
It is the early identification of people with emerging signs and symptoms of depression to enable timely, effective and appropriate treatment in order to prevent diagnosable illness and reduce the effects associated with symptoms.
Programs oriented toward early intervention aim to prevent the development of depression by enhancing a person’s protective factors and reducing their risk factors (or the impact of their risk factors), as well as helping them to deal effectively with their current level of symptoms.
These interventions occur shortly after a need has arisen, aiming to reduce distress, shorten the episode of care and minimise the level of intervention required. By doing so, early intervention aims to reduce dependency and the effects that are often associated with symptoms of depressions, as well as enhance hope for future wellbeing (Gardner, 1996).
The definition of early intervention includes indicated prevention, whereas universal and selective prevention interventions are defined solely as prevention. This conceptually distinguishes prevention approaches depending on the presence or absence of signs and symptoms of disorder.
Universal and selective prevention interventions take place in the absence of any current signs and symptoms of depression, whereas indicated prevention takes place when minimal but detectable signs and symptoms of the disorder are present.
Often, however, like the distinction between promotion and prevention, the distinction between prevention and early intervention is not clear-cut; particularly given the near-impossibility in most cases of pinpointing the start of the early signs and symptoms of depression.
Treatment: Treatment is made up physical and psychological treatments for people with diagnosed disorders. Standard treatment involves the application of effective, evidence-based treatments for individuals with diagnosed disorders. The aim is to provide the most effective treatment to achieve the fullest possible recovery.
Continuing Care: It comprises interventions for individuals whose depression continue or reoccur. The aim is to provide optimal clinical treatment and the necessary rehabilitation and support services in order to maintain optimal functioning to promote recovery. Rehabilitation may focus on vocational, educational, social and cognitive functioning.
Ongoing mental health promotion, the reduction of risk factors and the enhancement of protective factors are still relevant at this end of the spectrum, to facilitate and support recovery and ongoing wellbeing.
Relapse (Tertiary) Prevention: Relapse prevention refers to interventions in response to the early signs of reoccurring depression. Relapse prevention is a critical issue for this group of people, their families, mental health services and the wider community. Recognition of the early signs of recurrent disorder and the appropriate treatment responses comprise a unique area of investigation.
While many of the issues related to early interventions are also relevant to relapse prevention, such as the possibility that quite different factors may influence the relapse and recurrence of a disorder than those that influence its onset.
- Gardner, S. (1996). Psychological Aspects of Early Treatment Interventions. In Riley, C., Warner, M., Piggot, C., Pullen, A. (Eds.). Releasing Resources to Achieve Health Gain. Oxford: Radcliffe Medical Press, pages 143-148.
- Mrazek, P. & Haggerty, R.J. (1994). Reducing Risks for Mental Disorders. Washington: National Academy Press.