Eficácia de intervenções na prevenção de transtornos de humor: um overview de revisões sistemáticas com meta-análise
DOI:
https://doi.org/10.25118/2763-9037.2026.v16.1542Palavras-chave:
Transtornos de humor;, transtorno depressivo, transtorno bipolar, intervenção, prevençãoResumo
Introdução: Os transtornos do humor são condições altamente prevalentes, associadas a importante carga clínica, social e econômica em todo o mundo. Apesar desse impacto, ainda há escassez de diretrizes baseadas em evidências sobre intervenções preventivas, especialmente no que se refere à prevenção do surgimento e da recorrência dessas condições. Objetivo: Avaliar a eficácia de intervenções preventivas para transtornos depressivos e transtorno afetivo bipolar por meio de um overview de revisões sistemáticas com meta-análises. Métodos: Este overview seguiu as diretrizes PRISMA e foi prospectivamente registrado no PROSPERO (CRD42022323580). Foram identificadas revisões sistemáticas com meta-análises publicadas entre 2010 e 2021 nas bases SciELO, LILACS, MEDLINE/PubMed e Cochrane Database of Systematic Reviews. Incluíram-se revisões que abordaram prevenção primária, secundária ou terciária dos transtornos do humor. A qualidade metodológica foi avaliada por meio das ferramenta AMSTAR-2. Resultados: Vinte e quatro revisões sistemáticas preencheram os critérios de inclusão. Para a prevenção primária, houve evidência apenas para o transtorno depressivo, indicando que intervenções psicológicas e psicossociais, como terapia cognitivo-comportamental, terapia interpessoal, psicoeducação, programas baseados em mindfulness e intervenções familiares, estiveram associadas à redução da incidência de episódios depressivos em populações de risco, incluindo crianças, adolescentes, adultos, mulheres no período perinatal e indivíduos pós-acidente vascular cerebral. Os estudos de prevenção secundária e terciária concentraram-se principalmente na prevenção de recaída e recorrência. No transtorno depressivo maior, tanto intervenções psicológicas quanto tratamentos farmacológicos de manutenção reduziram significativamente o risco de recaída, sendo que abordagens combinadas frequentemente apresentaram melhores resultados. No transtorno afetivo bipolar, a farmacoterapia de manutenção com estabilizadores do humor e antipsicóticos de segunda geração, assim como intervenções estruturadas de psicoeducação, demonstraram eficácia na prevenção de novos episódios do humor. Entretanto, a maioria das revisões apresentou qualidade metodológica baixa ou criticamente baixa, refletindo heterogeneidade, amostras reduzidas e escassez de dados longitudinais. Conclusões: As intervenções preventivas para os transtornos do humor, especialmente estratégias psicológicas, psicossociais e farmacológicas de manutenção, demonstram eficácia consistente na redução da incidência e da recorrência em diferentes populações. Embora a evidência disponível seja limitada por fragilidades metodológicas, os achados sustentam recomendações presentes em diretrizes internacionais e reforçam a prevenção como um componente central do cuidado em saúde mental. O fortalecimento da psiquiatria preventiva, por meio de pesquisas mais robustas e de sua incorporação às políticas públicas de saúde, pode contribuir de forma significativa para a redução do impacto dos transtornos do humor a longo prazo.
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