Depression Guidelines Research Articles

Multilevel barriers to guideline implementation: a nationwide multi-professional cross-sectional study within child and adolescent psychiatry

BackgroundDespite efforts to promote guideline use, guideline adoption is often suboptimal due to failure to identify and address relevant barriers. Barriers vary not only between guidelines but also between settings, intended users, and targeted patients. Multi-professional guidelines are often used in child and adolescent mental health services (CAMHS), making the implementation process more difficult. Despite this, there is a lack of knowledge about which barriers to consider or if barriers vary by profession. The aim of this study was to address these gaps by examining barriers to adopting a multi-professional depression guideline in the context of a nationwide implementation study.Methods440 CAMHS clinicians across Sweden (52%) completed the Barriers and Facilitators Assessment Instrument (BFAI) ahead of an implementation endeavour. BFAI is a widely used and validated measure of guideline implementation on four scales: Innovation, Provider, Context, and Patient. Barriers were calculated at scale and at item levels. ANOVA and chi-square tests were used to analyse differences by profession and effect sizes were calculated.ResultsOverall, clinicians were optimistic about guideline uptake, particularly about guideline characteristics and their own adoption ability. Barriers were related to the patient and the context domains, as well as to individual clinician knowledge and training. Perceptions differed across professions; psychiatrists were most, and counsellors were least positive about guideline embeddedness.ConclusionThis large-scale quantitative study suggests that CAMHS clinicians have an overall favourable attitude towards guideline adoption but highlights the need for adaptations to certain patient groups. Strategies to improve guideline use should primarily address these patient issues while securing proper support to the implementation. Implementation efforts, particularly those targeting staff knowledge, training, and involvement, may benefit from being tailored to different professional needs. These findings may inform implementation projects in CAMHS and future research.

Association between neighborhood socioeconomic status and healthcare utilization among individuals with a first diagnosis of major depressive disorder in primary care in the Stockholm region

BackgroundPopulation-based surveys suggest that low socioeconomic status (SES) is associated with higher prevalence of depressive symptoms, while their healthcare utilization is not necessarily higher. ObjectiveTo investigate the association between neighborhood socioeconomic status (NSES) and healthcare utilization among individuals diagnosed with major depressive disorder (MDD). MethodThis was a retrospective longitudinal study of all adults with a first MDD diagnosis within primary care during 2010–2018. NSES was defined by the household area of residence using the Mosaic™ classification. Outcomes were AD (antidepressants) (N06A) dispensation and psychiatric outpatient visit, both of which are outlined as options in depression guidelines. Cox multivariable regression was used for the time to event analyses. ResultsA total of 117,193 individuals were included, of which 87,499 (75 %) were dispensed an AD and 35,989 (31 %) had a recorded psychiatric outpatient visit. Low NSES was associated with lower rate of AD dispensation in the first-year post-diagnosis (HR: 0.95, 95 % CI: 0.93–0.96, p < 0.001) and higher rate of psychiatric visit (HR: 1.10, 95 % CI: 1.07–1.12, p < 0.001) compared with high NSES. LimitationsData sources have high coverage. A minority of psychiatric care provided by non-publicly financed providers was not included. It was not possible to adjust for depression severity. ConclusionSocioeconomic status as measured by the neighborhood of residency was associated with AD dispensation and psychiatric outpatient visit in MDD, also in a healthcare system with virtually free access. This is of relevance for clinical practice, considering the focus on equity of care and the increase in depression prevalence worldwide.

A Briefing on the Canadian Mood and Anxiety Disorder Treatment (Canmat) 2023 Depression Guidelines and Advice for Their Application in Primary Care

The Canadian Mood And Anxiety Disorder Treatment (CANMAT) guidelines for depression, last published in 2016, have now been updated with literature through to 2023, and have been recently published in 2024 (Lam et al , Canadian J Psych, In press 2024). This 92-page document thoroughly addresses aspects of depression management, using evidence based on the literature, and supplemented by an expert consensus of the 57 co-authors. While thorough, this document remains cumbersome for a busy primary care clinician to sort through and apply to everyday practice. Here, we present a summary of evidence for the treatment of depression, along with practical advice for clinical decision making in primary care.

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.

Care pathways, prescribing practices and treatment outcomes in major depressive disorder and treatment-resistant depression: retrospective, population-based cohort study.

Despite the availability of effective therapies, many patients with major depressive disorder (MDD) develop treatment-resistant depression (TRD). To evaluate and compare prescribing patterns, contact with specialist services and treatment outcomes in patients with MDD and TRD. This was a retrospective analysis of linked primary and secondary care National Health Service data in the north-west London Discover-NOW data-set. Eligible patients were adults who had diagnostic codes for depression and had been prescribed at least one antidepressant between 2015 and 2020. A total of 110 406 patients were included, comprising 101 333 (92%) with MDD and 9073 (8%) with TRD. Patients with TRD had significantly higher risks of suicidal behaviour and comorbidities such as anxiety, asthma, and alcohol or substance misuse (all P < 0.0001). Citalopram, sertraline, fluoxetine and mirtazapine accounted for 83% of MDD and 71% of TRD prescriptions. Use of antidepressant switching (1% MDD, 7% TRD) and combination therapy (1%, 5%) was rare, whereas augmentation occurred more frequently in the TRD group (4%, 35%). Remission was recorded in 42 348 (42%) patients with MDD and 1188 (13%) with TRD (P < 0.0001), whereas relapse was seen in 20 970 (21%) and 4923 (54%), respectively (P < 0.0001). Mean times from diagnosis to first contact with mental health services were 38.9 (s.d. 33.6) months for MDD and 41.5 (s.d. 32.0) months for TRD (P < 0.0001). There appears to be a considerable difference between treatment guidelines for depression and TRD and the reality of clinical practice. Long-term treatment with single antidepressants, poor remission, and high relapse rates among patients in primary care highlight the need to optimise treatment pathways and access to newer therapies.

The Possibilities of Modern Client-Centered and Experiential Psychotherapy

In Ukraine, important processes are underway to identify those areas of psychotherapy that deserve official recognition by law. The official recognition of psychotherapeutic methods and techniques is associated with the fact that they are recognized as clinically and statistically effective. Such psychotherapy is reimbursed by insurance and is actively promoted in training courses, often "at the expense of other methods of psychotherapy." The psychotherapeutic procedure itself is becoming more and more standardized and impersonal, conforming to a protocol. The fate of client-centered and experiential psychotherapy (PCE-therapy) is not so easy in the world: evidence of its effectiveness is not reflected in the NICE (National Center for Collaboration in Mental Health) guidelines for depression and schizophrenia, which to some extent determine health policy. Therefore, there are widespread prejudices about the ineffectiveness of this type of therapy: it is not effective for severe mental illness, crisis states, specific phobias and traumas, behavioral problems, for those clients who need a directive approach, for assessing and diagnosing clients, etc. The article presents specific studies of the effectiveness of client-centered and experiential psychotherapy for specific symptoms (anxiety, depression, schizophrenia, borderline personality disorders, and some somatic disorders), as well as data from a meta-analysis of the effectiveness of client-centered and experiential therapy. PCE-therapy proved to be highly effective according to the criteria: "before-after" treatment; 2) "treatment-no treatment"; 3) "comparison with other types of psychotherapy" - the data obtained are generally statistically and clinically equivalent in terms of effectiveness to other methods of psychotherapy. PCE therapy proved to be the most effective in the following cases: interpersonal problems, self-harming behavior, coping with chronic somatic diseases, psychosis. It turned out that cognitive behavioral therapy (CBT) has mixed benefits compared to PCE therapy. However, Elliott et al. note that, firstly, these "studies were mostly performed by CBT therapists" and, secondly, "low-quality versions of PCE therapy were used as comparison conditions". The most effective methods of PCE therapy were EFT and PCT. A list of approaches included in PCA-therapy is given, and their general characteristics are given.

Mental health support program (MHS) – Case report from Slovenia

Abstract Background MHS is a program adapted for general public. It aims to increase knowledge and awareness about mental disorders and equip individuals with skills to recognize and respond to people in mental distress. The program increases the potential for a timely intervention and reduces stigma and as such adds to combating public mental health problems. The aim of this presentation is to present the development and implementation of the MHS program in Slovenia. Objectives We developed and adapted MHS guidelines for depression and suicidality, launched a social media campaign and prepared a short awareness-raising film on MHS. Central to the intervention is a 5-hour educational program, covering a theoretical and a practical part on how to recognize, approach and help an individual. We were interested if (i) the program increases the knowledge of participants in regards to related topics and (ii) it affects their self-perceived competencies to approach and help an individual. Results The program was free of charge, open to the public and delivered to groups of maximum 25 participants (so far five groups). The evaluation showed that the program was well received, especially the practical parts (role-play). The participants reported of having acquired new knowledge, felt more confident in recognizing and responding to mental health problems and exhibited a higher level of self-perceived competencies to approach and help someone in distress. The results are of preliminary nature, but the first insights are promising. Conclusions Lack of knowledge can directly hinder offering help to someone who is in mental distress. Support, even when offered by an informal source, can positively affect help seeking behavior of those in need and potentially be lifesaving. Key messages • MHS can influence the timely recognition and referral to formal sources of help. • The program can contribute to narrowing the help seeking gap and influence mental health outcomes in the community.

Mental Health Is Heart Health: Adjusting Clinical Guidelines for Depression After Myocardial Infarction.

Mental Health Is Heart Health: Adjusting Clinical Guidelines for Depression After Myocardial Infarction.

Development of Practice Guidelines for Peripartum Depression in Primary Healthcare

Abstract Background Antenatal and postpartum major depressive episode (MDE) according to Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) is defined as either daily sustained sad mood or lack of enjoyment or desire for a minimum two weeks plus four associated manifestations (only three if the two major symptoms are present): 1) Unintentional notable slimming up or down; 2) Sleepiness or sleeplessness; 3)Tiredness sensation; 4) Guilty or futility sensation; 5) Declined concentration capacity; 6) Frequent suicidal thoughts or 7) Psychomotor excitation or delay, that start throughout pregnancy or during the first 4 weeks postpartum respectively. Objective To develop Egyptian practice guidelines for peripartum depression in Primary Healthcare (PHC). Methods The current study was conducted thorough Delphi technique by participation of Thirteen experts at psychiatry and family medicine specialties from different governmental universities, Ministry of Health and Population (MOHP), World Health Organization (WHO) and World Organization of Family Doctors (WONCA) via email thorough three consecutive phases of Delphi technique. Results The current study recommended health education programs, provision of awareness about physical exercise’s importance for prevention of antenatal and postnatal depression, adding telephone- based peer support for the preventive measures of the antenatal depression and family therapy for the postpartum depression prevention. Screening for all the pregnant women every trimester by patient health questionnaire II and screening for all the new mothers every well child clinic visit in the first year after delivery by Edinburg Postpartum Depression Scale (EPDS). Diagnosis by beck depression inventory II questionnaire and Postpartum Depression Screening Scale (PDSS) for antenatal and postnatal depression respectively with post diagnosis evaluation for: 1) Comorbid anxiety; 2) Bipolar disorder; 3) Thoughts of harming intrauterine fetus or newborns; 4) Suicidal thoughts and 5) Psychotic features. Cognitive Behavioral Therapy (CBT) for treatment of mild cases and CBT with half dose sertraline for moderate cases of antenatal depression. Cognitive Behavioral Therapy (CBT) for mild cases, CBT and the usual dose sertraline for moderate cases with no hormonal therapy for any patient. Referral for patients with: 1) severe depression; 2) comorbid anxiety; 3) bipolar disorder; 4) thoughts of harming intrauterine fetus or newborns; 5) suicidal thoughts; 6) psychotic features; 7) substance abuse. Conclusion development of Egyptian practice guidelines for peripartum depression in PHC. Wide dissemination of the practice guidelines to all the Egyptian PHC facilities via a suitable method and training programs for the family physicians on practicing these guidelines must be ensured.

The Delirium, Depression, and Dementia (3Ds) Clinical Practice Guideline: A Team Effort and Labor of Love

The Delirium, Depression, and Dementia (3Ds) Clinical Practice Guideline: A Team Effort and Labor of Love

Contradictions, methodological flaws, and potential for misinterpretations in ranking treatments of depression.

In this journal Malhi et al. recommended cognitive-behavior therapy (CBT), antidepressants, and counseling ahead of short-term psychodynamic therapy (STPP) referring to UK NICE guidelines for depression. However, these recommendations continue the ambiguous and therefore confusing NICE guidelines, which on the one hand list the above treatments as equal options as first-line treatment for depression and emphasizes the importance of patient preference and implementations factors, but on the other hand rank these first-line treatments, implying superiority of some treatments over others. Furthermore, we highlight several methodological flaws of the NICE treatment ranking and that the NICE treatment ranking is not justified by NICE's own and independent evidence and criteria. Presently it is not clear which patients benefit from which empirically-supported treatment. Thus, we continue to discourage the devaluing of efficacious treatments so that as many patients as possible may benefit from them.

Development of mental health first-aid guidelines for depression: a Delphi expert consensus study in Argentina and Chile

BackgroundDepression is one of the most common mental health problems worldwide and, while prevalence rates in Latin America are relatively high, most people who meet the criteria for diagnosis do not receive treatment. Family and friends of a person with depression can play an important role in supporting a person to seek and engage with treatment. However, many people do not have the necessary skills or confidence to help. English-language mental health first aid guidelines have been developed to support people to provide such help. The aim of this study was to culturally adapt these guidelines for Chile and Argentina.MethodsA Delphi expert consensus study was conducted with two expert panels, one of people with lived experience of depression (either their own or as a carer; n = 26) and one of health professionals (n = 29). Overall, 172 statements from the English-language guidelines were translated and compiled into a questionnaire. Participants were asked to rate statements based on how essential or important those statements were for Chile and Argentina and to suggest new statements if necessary.ResultsData were obtained over two survey rounds. Consensus was achieved on 172 statements. A total of 137 statements were adopted from the English-language guidelines, whereas 35 new endorsed statements were generated from panel suggestions. There were similarities between the English-language guidelines and those for Chile and Argentina. The adapted guidelines did not include some of the items from the English-language guidelines related to commenting on a person’s strengths or making judgements about their character, and also incorporated new items related to the incorporation of sociocultural considerations as causes of depression and attention to inequities in mental health.ConclusionsThe significant number of new items underscores the importance of undertaking a careful process of cultural adaptation. Further research on dissemination and incorporation of the guidelines into the Mental Health First Aid training course for Chile and Argentina is still required.

Improving Adolescent Depression in Primary Care: A Quality Improvement Initiative

The coronavirus disease 2019 pandemic has exacerbated and increased the prevalence of depression in adolescents. There is significant evidence supporting best practices for treating adolescent depression; yet, many adolescents remain unidentified or untreated by their primary care provider. For this quality improvement initiative, the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) were implemented in a primary care setting. After GLAD-PC implementation, 90% of participants identified as having depression received an intervention compared with 60% of patients in the baseline group. The results showed that implementing GLAD-PC led to a significant increase in the treatment of adolescent depression in primary care.

Cultural adaptation of the mental health first aid guidelines for depression in Brazil: a Delphi expert consensus study

BackgroundDepression is a significant contributor to disability in Brazil, with most Brazilians affected by depression receiving no treatment. As the community, including family and friends, plays a crucial role in providing support for someone with depression, it is important that evidence-based resources are available to support people who wish to help. The aim of this study was to culturally adapt the English-language mental health first aid guidelines for assisting a person with depression for the Brazilian culture.MethodsA Delphi expert consensus study was conducted, with two expert panels; health professionals (n = 29) and people with lived experience of depression (n = 28). One hundred and seventy-four statements from the English-language guidelines were translated into Brazilian Portuguese and administered as a survey. Participants were asked to rate statements based on how appropriate those statements were for the Brazilian culture and to suggest new statements if appropriate.ResultsData were collected over two survey rounds. Consensus was achieved on 143 statements. A total of 133 statements were adopted from the English-language guidelines, whereas 10 new endorsed statements were generated from suggestions of the two expert panels.ConclusionsThere were similarities between the English-language and Brazilian guidelines, mainly related to family involvement and the value of empathy. More research on dissemination and incorporation of the guidelines into the Mental Health First Aid (MHFA) training course for Brazil is required.

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.

A Review of Treatments and Clinical Guidelines for Perinatal Depression.

Perinatal depression occurs in approximately 1 in 7 women and is considered the most common complication of pregnancy and childbearing. Management of perinatal depression may include a combination of nonpharmacological and pharmacological therapies depending on the severity of symptoms, the stage of gestation, and maternal preference. Healthcare providers are recommended to review current guidelines and provide information to women during pregnancy and postpartum regarding the risks and benefits of nonpharmacological and pharmacological treatment options for perinatal depression. In addition, healthcare providers should consider common barriers to treatment including inadequate screening and social stigma. This article reviews common treatments of perinatal depression as well as the clinical guidelines provided by the American Association of Obstetricians and Gynecologists (ACOG), the American Psychiatric Association (APA), and the US Preventive Services Task Force (USPSTF). Discussion of nonpharmacological therapies includes cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). Pharmacological treatments are reviewed by drug class and include selective serotonin reuptake inhibitors (SSRIs), serotonin/norepinephrine reuptake inhibitors (SNRIs), norepinephrine/dopamine reuptake inhibitors (NDRIs), and tricyclic antidepressants (TCAs). Adjunctive treatments of severe depression, including second-generation antipsychotics (SGAs), are also discussed.

A Review of Treatments and Clinical Guidelines for Perinatal Depression.

The Journal of Perinatal & Neonatal Nursing: July/September 2022 - Volume 36 - Issue 3 - p E5 doi: 10.1097/JPN.0000000000000682

A Validated Postnatal Depression Screening Tool and Guideline to Improve Evidence-Based Screening for Postpartum Depression in Ambulatory Care

Postpartum depression is one of the most common diagnoses for maternal morbidity and mortality, affecting one in eight women in the United States. Initially, there was no universal process for the identification of postpartum depression in ambulatory clinics in a regional health system caring for obstetric patients, which puts patients and their newborns at risk for severe and potentially detrimental consequences. A quality improvement project was developed and implemented with a pilot group in the ambulatory setting.

Psychoeducational and Rehabilitation Intervention guideline for Late-Life Anxiety and Depression among the Older Adults at Geriatric Home

Psychoeducational and Rehabilitation Intervention guideline for Late-Life Anxiety and Depression among the Older Adults at Geriatric Home

Introducing and integrating perinatal mental health screening: Development of an equity-informed evidence-based approach.

Pregnancy is a time of increased risk for developing or re-experiencing mental illness. Perinatal mental health screening for all women is recommended in many national guidelines, but a number of systems-level and individual barriers often hinder policy implementation. These barriers result in missed opportunities for detection and early intervention and are likely to be experienced disproportionately by women from culturally and linguistically diverse backgrounds, including women of refugee backgrounds. The objectives of this study were to develop a theory-informed, evidence-based guide for introducing and integrating perinatal mental health screening across health settings and to synthesize the learnings from an implementation initiative and multisectoral partnership between the Centre of Perinatal Excellence (COPE), and a university-based research centre. COPE is a nongovernmental organization (NGO) commissioned to update the Australian perinatal mental health guidelines, train health professionals and implement digital screening. In this case study, barriers to implementation were prospectively identified and strategies to overcome them were developed. A pilot perinatal screening programme for depression and anxiety with a strong health equity focus was implemented and evaluated at a large public maternity service delivering care to a culturally diverse population of women in metropolitan Melbourne, Australia, including women of refugee background. Strategies that were identified preimplementation and postevaluation were mapped to theoretical frameworks. An implementation guide was developed to support future policy, planning and decision-making by healthcare organizations. Using a behavioural change framework (Capability, Opportunity, Motivation-Behaviour Model), the key barriers, processes and outcomes are described for a real-world example designed to maximize accessibility, feasibility and acceptability. A Programme Logic Model was developed to demonstrate the relationships of the inputs, which included stakeholder consultation, resource development and a digital screening platform, with the outcomes of the programme. A seven-stage implementation guide is presented for use in a range of healthcare settings. These findings describe an equity-informed, evidence-based approach that can be used by healthcare organizations to address common systems and individual-level barriers to implement perinatal depression and anxiety screening guidelines. These results present strategies that were informed by prior research involving patients and staff from a large public antenatal clinic in Melbourne, Australia. This involved interviews with health professionals from the clinic such as midwives, obstetricians, perinatal mental health and refugee health experts and interpreters. Interviews were also conducted with women of refugee background who were attending the clinic for antenatal care. A steering committee was formed to facilitate the implementation of the perinatal mental health screening programme comprising staff from key hospital departments, GP liaison, refugee health and well-being, the NGOCOPE and academic experts in psychology, midwifery, obstetrics and public health. This committee met fortnightly for 2 years to devise strategies to address the barriers, implement and evaluate the programme. A community advisory group was also formed that involved women from eight different countries, some of refugee background, who had recently given birth at the health service. This committee met bimonthly and was instrumental in planning the implementation and evaluation such as recruitment strategies, resources and facilitating an understanding of the cultural complexity of the women participating in the study.