Evaluation of evidence grades in psychiatry and psychotherapy guidelines

Lisa Löhrs,Mirjam Handrack,Alkomiet Hasan,Elias Wagner,Ina Kopp,Astrid Röh,Peter Falkai,Wolfgang Strube,Frank Jessen

doi:10.1186/s12888-020-02897-2

Abstract

BackgroundInformation regarding the distribution of evidence grades in psychiatry and psychotherapy guidelines is lacking. Based on the German evidence- and consensus- based (S3) psychiatry and psychotherapy and the Scottish Intercollegiate Guidelines Network (SIGN) treatment guidelines, we aimed to specify how guideline recommendations are composed and to what extent recommendations are evidence-based.MethodsData was collected from all published evidence- and consensus-based S3-classified psychiatry and psychotherapy guidelines. As control conditions, data from German neurology S3-classified guidelines as well as data from recent SIGN guidelines of mental health were extracted. Two investigators reviewed the selected guidelines independently, extracted and analysed the numbers and levels of recommendations.ResultsOn average, 45.1% of all recommendations are not based on strong scientific evidence in German guidelines of psychiatry and psychotherapy. A related pattern can be confirmed for SIGN guidelines, where the mean average of recommendations with lacking evidence is 33.9%. By contrast, in the German guidelines of neurology the average of such recommendations is 16.5%. A total of 24.5% of all recommendations in the guidelines of psychiatry and psychotherapy are classified as level A recommendations, compared to 31.6% in the field of neurology and 31.1% in the SIGN guidelines. Related patterns were observed for B and 0 level recommendations.ConclusionGuidelines should be practical tools to simplify the decision-making process based on scientific evidence. Up to 45% of all recommendations in the investigated guidelines of psychiatry and psychotherapy are not based on strong scientific evidence. The reasons for this high number remain unclear. Possibly, only a limited number of studies answer clinically relevant questions. Our findings thereby question whether guidelines should include non-evidence-based recommendations to be methodologically stringent and whether specific processes to develop expert-opinion statements must be implemented.

Highlights

Information regarding the distribution of evidence grades in psychiatry and psychotherapy guidelines is lacking
The dementia guideline as a joint publication of German Society for Psychiatry and Psychotherapy (DGPPN) and The German association for Neurology (DGN) was listed twice but was analysed as psychiatric guideline. 5 of 48 currently available Scottish Intercollegiate Guidelines Network (SIGN) guidelines were guidelines covering the domain of mental health
Our study shows for the first time that the relative mean frequency of recommendations in the German psychiatry and psychotherapy guidelines, which are not rooted in strong scientific evidence amounts to 45.1%

Summary

Introduction

Information regarding the distribution of evidence grades in psychiatry and psychotherapy guidelines is lacking. Evidence-based medicine aims to integrate the best research evidence with clinical expertise and patient values [1]. In this regard, guidelines are systematically developed tools to assist physicians and other health-care professionals in the decision-making process and to support the transparency of medical decisions. Guidelines are instruments of quality management of the healthcare system and viewed to improve quality and effectiveness of clinical as well as costs of healthcare [2]. In Germany, the development is only financed by the subscriptions of the publishing medical societies [3] and by the cost-free work of the people involved. Despite an important legislative initiative to improve the funding situation [6], it is not foreseeable that there will be a fundamental change regarding the way how guidelines are developed in Germany

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