Clinical Practice Guidelines For Depression Research Articles

A Cross Attention Approach to Diagnostic Explainability Using Clinical Practice Guidelines for Depression.

The lack of explainability in using relevant clinical knowledge hinders the adoption of artificial intelligence-powered analysis of unstructured clinical dialogue. A wealth of relevant, untapped Mental Health (MH) data is available in online communities, providing the opportunity to address the explainability problem with substantial potential impact as a screening tool for both online and offline applications. Inspired by how clinicians rely on their expertise when interacting with patients, we leverage relevant clinical knowledge to classify and explain depression-related data, reducing manual review time and engendering trust. We developed a method to enhance attention in contemporary transformer models and generate explanations for classifications that are understandable by mental health practitioners (MHPs) by incorporating external clinical knowledge. We propose a domain-general architecture called ProcesS knowledgeinfused cross ATtention (PSAT) that incorporates clinical practice guidelines (CPG) when computing attention. We transform a CPG resource focused on depression, such as the Patient Health Questionnaire (e.g. PHQ-9) and related questions, into a machine-readable ontology using SNOMED-CT. With this resource, PSAT enhances the ability of models like GPT-3.5 to generate application-relevant explanations. Evaluation of four expert-curated datasets related to depression demonstrates PSAT's applicationrelevant explanations. PSAT surpasses the performance of twelve baseline models and can provide explanations where other baselines fall short.

The management of depression: the evidence speaks for itself.

Comparing the recommendations of two recently published national clinical practice guidelines for depression, this editorial highlights the concordance of advice concerning the selection and sequencing of therapies. Lifestyle and psychological interventions feature prominently and there is broad agreement regarding medication choice and optimisation strategies. The guidelines are therefore a useful resource.

Evidence mapping of clinical practice guidelines recommendations and quality for depression in children and adolescents.

This study systematically reviewed the clinical practice guidelines (CPGs) for depression in children and adolescents and assessed the quality and recommendation consistency of those CPGs. Evidence mapping was presented to illustrate the research trends and identify gaps to guide future research. Literature on CPGs for depression was systematically collected from PubMed, Embase, Web of Science, guideline databases, and psychiatric association/ society websites. The basic information, recommendations, methodological quality, and reporting quality of CPGs were extracted, and the supporting evidence strength for the included CPGs was analyzed in Excel. Four appraisers independently assessed the eligible CPGs using AGREE II instrument and the RIGHT checklist. All recommendations from the CPGs were summarized and analyzed, and the evidence mapping bubble charts were plotted in Excel. After excluding 15,184 records, 12 depression CPGs were eventually proved eligible, six of which were of high quality and six medium quality. A total of 39 major recommendations were summarized, 35 of which were supported by high-quality CPGs. Although direct comparisons are challenging due to differences in grading schemes and research quality, most CPGs share many pivotal recommendations that can help guide clinical practice. However, the evidence for some clinical problems is still lacking. Thus, more research is necessary on the screening and treatment of children and adolescents to put forward more evidence-based and high-quality recommendations.

Critical appraisal of clinical practice guidelines for depression in children and adolescents

Background:Depression as a clinically significant and growing public health issue is the third leading cause of disability. Adolescent-onset depression has been associated with psychiatric, anxiety disorders, suicidality, medical comorbidities, and an elevated risk of major depressive disorder episodes later in life. How to effectively identify, prevent, and treat depression has become one of the key points of discussion among medical institutions/departments. With the importance of depression being emphasized, countries/organizations around the world have developed guidelines for clinical practice related to depression for different groups of people to guide medical staff to implement scientific, effective, and standardized depression management. However, the quality of such guidelines is not yet clear, which is not conducive to the selection of medical staff and affects clinical application to a certain extent. This study aims to evaluate the rigor of the development of clinical practice guidelines (CPGs) for depression in children and adolescents and will identify, in these documents, the recommendations for depression in children and adolescents.Methods:Electronic databases and specific databases of CPGs will be searched. Study selection and data extraction will be performed independently by 2 reviewers. The AGREE II Instrument and RIGHT checklist will be used to assess the methodological quality and reporting quality of included CPGs about depression in children and adolescents. We will also analyze consistency and inconsistency of the recommendations in CPGs, including assessment, diagnosis, screening, treatment, and management. Bubble charts will be used to show the differences in methodological and reporting quality. Subgroup analysis will be conducted according to the result of evaluation. Excel and Endnote X9 will be used.Results:Using the search drafts of electronic databases, we included 6 CPGs. The results of our study will be published in a peer-reviewed journal.Conclusions:Our study will provide systematic evidence for existing CPGs for depression in children and adolescents and provide a guidance for CPGs users.Protocol Registration:INPLASY202080002.

European clinical practice guidelines for depression in adults: Are they good enough?

BackgroundDespite the increasing attention given to evidence-based practice, little research has focused on the quality of clinical practice guidelines (CPGs) involving psychotherapy. The goal of the present study was to evaluate the quality of national CPGs for psychological treatments for depression in European countries. MethodsA search of the Guidelines International Network's library was conducted. Four guidelines met inclusion criteria for the study and were assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) platform. ResultsOverall, the guidelines included in the study were found to be of good quality, although two guidelines received low scores for applicability, and some did not provide information on competing interests or potential influences from funding bodies. LimitationsAlthough guidelines were retrieved from a well-known international library, some European guidelines for depression published elsewhere may have been overlooked. ConclusionsResults of this study provide support for the high quality of the guidelines reviewed, but also raise some concerns regarding editorial independence and the applicability of the guidelines, areas that should be the focus of improvement in future versions of these guidelines.

Characteristics and quality of clinical practice guidelines for depression in adults: a scoping review

BackgroundClinical Practice Guidelines (CPGs) should follow an adequate methodology using an evidence-based approach in order to provide reliable recommendations. However, little is known regarding the quality of CPGs for Depression, which precludes its adequate use by stakeholders and mental health professionals. Thus, the aim of this study was to conduct a scoping review to describe the characteristics and quality of CPGs for Depression in adults.MethodsWe searched CPGs for Depression in adults in eighteen databases. We included those that were published in English or Spanish between January 2014 and May 2018 and were based on systematic reviews of the evidence. Two independent authors extracted the characteristics, type and number of recommendations, and quality (using the Appraisal of Guidelines for Research and Evaluation-II [AGREE-II]) of each included CPG.ResultsWe included eleven CPGs, of which 9/11 did not include the participation of patients in the development of the CPG, 4/11 CPGs had a score ≥ 70% in the overall evaluation of AGREE-II, and 3/11 CPGs had a score ≥ 70% in its third domain (rigor of development). In addition, only 5/11 CPGs shared their search strategy, while only 4/11 listed the selected studies they used to reach recommendations, and 7/11 CPGs did not clearly state which methodology they used to translate evidence into a recommendation.ConclusionsMost of evaluated CPGs did not take into account the patient’s viewpoints, achieved a low score in the rigor of development domain, and did not clearly state the process used to reach the recommendations. Stakeholders, CPCGs developers, and CPGs users should take this into account when choosing CPGs, and interpreting and putting into practice their issued recommendations.

Difficult-to-treat depression: A clinical and research roadmap for when remission is elusive.

The report considers the pros and cons of the most commonly used conceptual model that forms the basis for most clinical practice guidelines for depression. This model promotes the attainment of sustained symptom remission as the treatment goal based on its well-established prognostic and functional importance. Sustained remission is very unlikely, however, after multiple treatment attempts. Our current model propels many clinicians to continue to change or add treatments despite little chance for remission or full functional restoration and despite the increasing risk of more adverse events from polypharmacy. An alternative 'difficult-to-treat depression' model is presented and considered. It accepts that the treatment aims for some depressed patients may shift to optimal symptom control rather than remission. When difficult-to-treat depression is suspected, the many treatable causes of persistent depression must be assessed and addressed (given the importance of remission when attainable) before difficult-to-treat depression can be ascribed. The clinical and research implications of the difficult-to-treat depression model are discussed. Suspected difficult-to-treat depression provides a practical basis for considering when to conduct a comprehensive evaluation. Once difficult-to-treat depression is confirmed, treatment may better focus on optimal disease management (symptom control and functional improvement).

Conflict of Interest Policies and Industry Relationships of Guideline Development Group Members: A Cross-Sectional Study of Clinical Practice Guidelines for Depression

ABSTRACTBecause of increased attention to the issue of trustworthiness of clinical practice guidelines, it may be that both transparency and management of industry associations of guideline development groups (GDGs) have improved. The purpose of the present study was to assess a) the disclosure requirements of GDGs in a cross-section of guidelines for major depression; and, b) the extent and type of conflicts of panel members. Treatment guidelines for major depression were identified and searched for conflict of interest policies and disclosure statements. Multi-modal screens for undeclared conflicts were also conducted. Fourteen guidelines with a total of 172 panel members were included in the analysis. Eleven of the 14 guidelines (78%) had a stated conflict of interest policy or disclosure statement, although the policies varied widely. Most (57%) of the guidelines were developed by panels that had members with industry financial ties to drug companies that manufacture antidepressant medication. However, only a minority of total panel members (18%) had such conflicts of interest. Drug company speakers bureau participation was the most common type of conflict. Although some progress has been made, organizations that develop guidelines should continue to work toward greater transparency and minimization of financial conflicts of interest.

A provincial adaptation of clinical practice guidelines for depression in primary care: a case illustration of the ADAPTE method.

Mental health services for patients with a major depressive disorder are commonly delivered by primary care. To support the uptake of clinical practice guidelines in primary care, we developed and disseminated a practice protocol for depression tailored for a multidisciplinary audience of primary mental health care providers with the ADAPTE methodology. The research questions addressed in this study aimed at examining the experience of the development process of a mental health practice protocol in terms of adaptation, facilitation and implementation. We present a descriptive case study of the development and implementation of a practice protocol for major depressive disorder for primary mental health care in the organizational and cultural context of the province of Québec (Canada), following the steps of the ADAPTE methodology. An expert committee composed of general practitioners, mental health specialists, health care administrators and decision makers at regional and provincial levels participated in the protocol development process. The practice protocol was based on two clinical practice guidelines: the NICE guideline on the treatment and management of depression in adults (2009, 2010) and the Canadian Network for Mood and Anxiety Treatments clinical guidelines for the management of major depressive disorder in adults (2009). A stepped care model was embedded in the protocol to facilitate the implementation of clinical recommendations in primary mental health care. A multifaceted dissemination strategy was used to support the uptake of the protocol recommendations in clinical practice. The ADAPTE methodology provided structure, rigour and efficiency to the trans-contextual adaptation of guideline recommendations. We will share the challenges associated with the adaptation of clinical recommendations and organizational strategies for a mental health guideline, and the dissemination of the practice protocol in primary care.

Detection and management of mood disorders in the maternity setting: The Australian Clinical Practice Guidelines

Mood disorders arising in the perinatal period (conception to the first postnatal year), occur in up to 13% of women. The adverse impact of mood disorders on mother, infant and family with potential long-term consequences are well documented. There is a need for clear, evidence-based, guidelines for midwives and other maternity care providers. To describe the process undertaken to develop the Australian Clinical Practice Guidelines for Depression and Related Disorders in the Perinatal Period and to highlight the key recommendations and their implications for the maternity sector. Using NHMRC criteria, a rigorous systematic literature review was undertaken synthesising the evidence used to formulate graded guideline recommendations. Where there was insufficient evidence for recommendations, Good Practice Points were formulated. These are based on lower quality evidence and/or expert consensus. The quality of the evidence was good in regards to the use of the Edinburgh Postnatal Depression Scale and psychological interventions, but limited as regards medication use and safety perinatally. Recommendations were made for staff training in psychosocial assessment; universal screening for depression across the perinatal period; and the use of evidence based psychological interventions for mild to moderate depression postnatally. Good Practice Points addressed the use of comprehensive psychosocial assessment--including risk to mother and infant, and consideration of the mother-infant interaction--and gave advice around the use and safety of psychotropic medications in pregnancy and breastfeeding. In contrast to their international counterparts, the Australian guidelines emphasize a more holistic, woman and family centred approach to the management of mental health and mood disorders in the perinatal setting. The development of these Guidelines is a first step in translating evidence into practice and providing Australian midwives and other maternity care providers with clear guidance on the psychosocial management of women and families.

Group cognitive-behavioral therapy for patients with epilepsy and comorbid depression and anxiety

Clinical Practice Guidelines for depression and anxiety recommend cognitive-behavioral therapy (CBT) as an equivalent and sometimes more effective treatment than medication. The limited research investigating CBT for anxiety and depression in epilepsy demonstrates mixed results. Described here is a pilot project using an existing group CBT intervention for symptoms of depression and/or anxiety, CBT Basics II, in patients with epilepsy. Eighteen patients with epilepsy, referred by neurologists to address depression and/or anxiety symptoms, completed the 10-week group. Results demonstrated improvements in depression, anxiety, negative automatic thoughts, and cognitive therapy knowledge and skills. The group was generally acceptable to patients as indicated by good attendance rates and only one dropout. This pilot project demonstrates that group CBT is a feasible, acceptable, and promising intervention for patients with epilepsy and comorbid depression and anxiety symptoms.

S19– Gender analysis of clinical practice guidelines for depression from four European countries: Austria, Finland, Sweden, and the United Kingdom

S19– Gender analysis of clinical practice guidelines for depression from four European countries: Austria, Finland, Sweden, and the United Kingdom

From ‘postnatal depression’ to ‘perinatal anxiety and depression’: Key points of the National Perinatal Depression Plan for nurses and midwives in Australian primary health care settings

Background: Perinatal anxiety and depression constitute one of the long term major public health issues in Australia and for too long they has been bundled under the over-arching term of ‘postnatal depression’. However, the generation, funding, and implementation of the National Perinatal Depression Plan (NPDP) (Australian Government Department of Health and Ageing, 2008), across all Australian States and Territories, are proving to be wide-reaching and influential. Not only does the NDPD move from the umbrella term of ‘postnatal depression’ to establish the reality of perinatal anxiety and depression which women can experience from conception to the first year of the infant’s life but also all States and Territories have made Individual Investment Plans for the implementation of the NPDP. Implementation: In these Investment Plans, each State and Territory will address the following three major goals of the NPDP differently and mainly within a primary health care setting: (1) Psychosocial assessment in addition to screening of women antenatally and postnatally; (2) Education of health professionals about the complexity of perinatal depression and the need for early assessment and intervention; (3) Development of quality pathways of care for follow-up support and care of women who are depressed and who are assessed as being at the risk for depression. Implications for nurses and midwives: General nurses, maternal child health nurses, midwives, and mental health nurses are spread throughout primary health care settings. Three essential aspects of the NPDP are pertinent to their practice: (1) the Edinburgh Postnatal Depression Scale (EPDS); the 2008 beyondblue National Action Plan for Perinatal Mental Health (NAP); and the Draft beyondblue Clinical Practice Guidelines for depression and related disorders – anxiety, bipolar disorder, and puerperal psychosis – in the perinatal period (March 2010). The author addresses these three aspects of the NPDP by citing two personal accounts by women who have experienced perinatal anxiety and depression; these accounts are available in the public domain.

Treating depression in nursing homes: practice guidelines in the real world.

Depression in nursing home residents is a common phenomenon, though there is a wide range in the severity of this disorder as experienced by elderly adults in the United States. Treating older patients for depression is costly in both human and financial terms. The authors review guidelines and recommendations for the diagnosis of depression and medical treatment of depressed elderly adults from the 1993 Clinical Practice Guidelines for Depression in Primary Care by the US Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality), making note also of similar guidelines provided by the American Medical Directors Association in 1996 and those provided by the American Psychiatric Association in 2000. In November 1999, the authors used a Delphi survey to gather data from prescreened panelists (N = 10) to have the panel review and clarify the importance and feasibility of each "A" rated item in the US Agency for Health Care Policy and Research guidelines. This research allows health care providers to evaluate the importance and feasibility of items related to the delivery of mental health services for the elderly in nursing homes.

In reply: Clinical practice guidelines for depression in young people

In reply: Clinical practice guidelines for depression in young people

Clinical practice guidelines for depression in young people: are the treatment recommendations outdated?

The 1997 NHMRC clinical practice guidelines for depression in young people included recommendations for treatment that need to be modified in light of more recent research. Changes to the guidelines should include the findings that selective serotonin reuptake inhibitors and some forms of psychotherapy are effective in treating adolescent depression. It is increasingly recognised that depression in adolescents often recurs and that prevention of recurrences should be a priority for research and practice.

Implementing practice guidelines for depression: Applying a new framework to an old problem

We discuss the challenges of implementing clinical practice guidelines for depression in the primary care setting. Multiple potential barriers can limit physician guideline adherence and translation of research into improved patient outcomes. Six primary barriers relate to providers (lack of awareness, lack of familiarity, lack of agreement, lack of self efficacy, lack of outcome expectancy, and inertia of previous practice). In addition, factors related to patient, guideline, and practice environment factors encompass external barriers to adherence. By delineating the underlying barriers to adherence, different interventions that are tailored to improve physician adherence to guidelines can be utilized. We review examples of these barriers, as well as interventions to improve guideline adherence. We also review characteristics of successful interventions to improve physician adherence to guidelines for depression. Since different physicians and practice settings may encounter a variety of barriers, multifaceted interventions that are not focused exclusively on the physician tend to be most effective.

Clinical Practice Guidelines for Depression in Primary Care: What Social Workers Need to Know

In April 1993, the government issued guidelines for the treatment of major depression in primary care, stressing a pharmacological approach. Although several professional associations have endorsed these guidelines, the American Psychological Association has declined to do so. Primary care physicians consult with social workers on mental health issues, so social workers need to be aware of the questions that have been raised in the context of the controversy over the guidelines. An educated position on the controversy can only come from familiarity with the empirical literature on the research-based benefits and costs of drug treatment versus psychotherapy for major depression. This article offers the needed literature review, after first summarizing the nature of the depression-guidelines controversy.