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Universal prevention of depression at schools: dead end or challenging crossroad?
  1. Pim Cuijpers1,2
  1. 1 Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
  2. 2 Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
  1. Correspondence to Professor Pim Cuijpers, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam 1081, The Netherlands; p.cuijpers{at}


Universal school programmes aimed at the prevention of depression and other common mental health problems in adolescents are attractive because they are less stigmatising than targeted interventions, have a high uptake and may shift the ‘normal distribution’ of mental health problems in the positive direction. Research up to now shows small effects of these interventions, but even small effects may have a large impact because of the large number of people receiving these interventions. However, such small effects may also be related to the modest quality of the trials in this area. This means that current research has no clear indication whether universal prevention has a large public health impact or no impact at all. The MYRIAD trial is a large, fully powered, high-quality study showing that universal prevention probably is not effective, although it it is possible that other interventions or approaches do have significant effects. We should seriously consider to move to other approaches to reduce the disease burden of depression in adolescents. Indirect approaches seem to be a feasible and promising alternative approach to prevention and increase the uptake of effective interventions.

  • Depression & mood disorders
  • Child & adolescent psychiatry

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  • Contributors PC is the only author this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.