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Courtney D, Mason J, Amani B, Rodak T, Szatmari P, Henderson J, de Oliveira C. Economic evaluations of treatment of depressive disorders in adolescents: Protocol for a scoping review. Early Interv Psychiatry 2024; 18:391-396. [PMID: 38323501 DOI: 10.1111/eip.13498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/28/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
AIM Depressive disorders in adolescents are common and impairing. Evidence-based treatments are available; however, at a cost. In the context of the COVID-19 pandemic, we anticipate increased demand for treatment services for adolescents with depression. We also anticipate that economic resources will be strained. Identifying cost-effective strategies to optimally treat depression in adolescents is imperative. This protocol for a scoping review aims to describe the literature with respect to economic evaluations of treatments for depression in adolescents. METHODS We will conduct a scoping review using established methods and reporting guidelines. MEDLINE, Embase, PsyclNFO, Econlit, and the International HTA Database will be searched from inception to June 13, 2023, with an update closer to time of manuscript submission, while the NHS Economic Evaluation Database archives will be searched from inception to December 2014. Publications that contain economic evaluations, in the context of a clinical trial or a model-based study, testing a treatment of depression in adolescents will be selected for inclusion. Extracted data items will include: economic evaluation perspectives, health outcome variables and costs used in economic evaluations, types of analyses performed, as well as quality of reporting and methodology. RESULT A narrative synthesis with summary tables will be used to describe our findings. CONCLUSION Our findings will help identify gaps in the literature with respect to economic analyses for the treatment of depression such that these gaps can be filled with future research. Policy-makers, funders and administrators may also use our findings to inform their decisions around provision of various treatments for depression in adolescents. REGISTRATION osf.io/5fteb (note that information on this link will be updated upon acceptance for publication based on reviewer comments).
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Affiliation(s)
- Darren Courtney
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Joyce Mason
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Bahar Amani
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Terri Rodak
- CAMH Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Szatmari
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jo Henderson
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Gajaria A, Greenblatt A, Prebeg M, Relihan J, Peter Szatmari, Courtney DB. Talking 'Bout Better outcomes for Adolescent Depression: Youth and Caregiver Perspectives on an Integrated Care Pathway for Depression. Clin Child Psychol Psychiatry 2024; 29:453-465. [PMID: 37394898 DOI: 10.1177/13591045231184916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
BACKGROUND Depression is a common condition among adolescents, with rates continuing to rise. A gap exists between evidence-based recommendations for the treatment of depression and clinical practice. Integrated Care Pathways (ICPs) can help address this gap, but to date no study has examined how young people and their caregivers experience ICPs and whether these pathways are an acceptable form of care. This study used focus groups with adolescents, caregivers, and service providers to examine experiences of an ICP. METHODS Six individual interviews with service providers, four focus groups with youth, and two focus groups with caregivers were completed. Data was analyzed consistent with Braun & Clarke's Thematic Analysis Framework within an interpretivist paradigm. RESULTS AND CONCLUSION The study demonstrated that ICPs are acceptable to youth and their caregivers and that ICPs facilitate shared decision making between youth/caregivers and care providers. Findings also indicated that youth are willing to engage with ICPs particularly when there is a trusted clinician involved who helps interpret and tailor the ICP to the young person's experience. Further questions include how to best integrate these into the overall system and how to further tailor these pathways to support youth with diagnostic complexity and treatment resistance.
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Affiliation(s)
- Amy Gajaria
- Margaret and Wallace McCain Centre for Child, Youth, & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andrea Greenblatt
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, ON, Canada
| | - Matthew Prebeg
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Darren B Courtney
- Margaret and Wallace McCain Centre for Child, Youth, & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Courtney DB, Barwick M, Amani B, Greenblatt AT, Aitken M, Krause KR, Andrade BF, Bennett K, Cleverley K, Uliaszek AA, de Oliveira C, Hawke LD, Henderson J, Wang W, Watson P, Gajaria A, Newton AS, Ameis S, Relihan J, Prebeg M, Chen S, Szatmari P. An Integrated Care Pathway for depression in adolescents: protocol for a Type 1 Hybrid Effectiveness-implementation, Non-randomized, Cluster Controlled Trial. BMC Psychiatry 2024; 24:193. [PMID: 38459453 PMCID: PMC10921633 DOI: 10.1186/s12888-023-05297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/22/2023] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Our group developed an Integrated Care Pathway to facilitate the delivery of evidence-based care for adolescents experiencing depression called CARIBOU-2 (Care for Adolescents who Receive Information 'Bout OUtcomes, 2nd iteration). The core pathway components are assessment, psychoeducation, psychotherapy options, medication options, caregiver support, measurement-based care team reviews and graduation. We aim to test the clinical and implementation effectiveness of the CARIBOU-2 pathway relative to treatment-as-usual (TAU) in community mental health settings. METHODS AND ANALYSIS We will use a Type 1 Hybrid Effectiveness-Implementation, Non-randomized Cluster Controlled Trial Design. Primary participants will be adolescents (planned n = 300, aged 13-18 years) with depressive symptoms, presenting to one of six community mental health agencies. All sites will begin in the TAU condition and transition to the CARIBOU-2 intervention after enrolling 25 adolescents. The primary clinical outcome is the rate of change of depressive symptoms from baseline to the 24-week endpoint using the Childhood Depression Rating Scale-Revised (CDRS-R). Generalized mixed effects modelling will be conducted to compare this outcome between intervention types. Our primary hypothesis is that there will be a greater rate of reduction in depressive symptoms in the group receiving the CARIBOU-2 intervention relative to TAU over 24 weeks as per the CDRS-R. Implementation outcomes will also be examined, including clinician fidelity to the pathway and its components, and cost-effectiveness. ETHICS AND DISSEMINATION Research ethics board approvals have been obtained. Should our results support our hypotheses, systematic implementation of the CARIBOU-2 intervention in other community mental health agencies would be indicated.
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Affiliation(s)
- Darren B Courtney
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada.
| | - Melanie Barwick
- University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Bahar Amani
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
| | - Andrea T Greenblatt
- University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Madison Aitken
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
| | - Karolin R Krause
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
| | - Brendan F Andrade
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Kathryn Bennett
- Department of Health Research Methods, Evidence, and Impact (Formerly Clinical Epidemiology and Biostatistics), McMaster University, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - Kristin Cleverley
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | | | | | - Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Jo Henderson
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Priya Watson
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
| | - Amy Gajaria
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Amanda S Newton
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Stephanie Ameis
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
| | - Jacqueline Relihan
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
| | - Matthew Prebeg
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Sheng Chen
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
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Yan M, Chen L, Yang M, Zhang L, Niu M, Wu F, Chen Y, Song Z, Zhang Y, Li J, Tian J. Evidence mapping of clinical practice guidelines recommendations and quality for depression in children and adolescents. Eur Child Adolesc Psychiatry 2023; 32:2091-2108. [PMID: 35262810 DOI: 10.1007/s00787-022-01958-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 02/06/2022] [Indexed: 02/05/2023]
Abstract
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.
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Affiliation(s)
- Meili Yan
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
| | - Lingmin Chen
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Min Yang
- Comprehensive Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Zhang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
- The Third Ward of Cardiovascular Clinical Medical Center, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Mingming Niu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
| | - Fangfang Wu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
- Shangluo Vocational and Technical College, Shangluo, Shanxi, China
| | - Yamin Chen
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
| | - Ziwei Song
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
| | - Yonggang Zhang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiang Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, China.
| | - Jinhui Tian
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China.
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China.
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, Gansu, China.
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Dryjańska N, Kiliś-Pstrusińska K. Depression in Children and Adolescents with Chronic Kidney Disease-Review of Available Literature. J Clin Med 2023; 12:jcm12103554. [PMID: 37240660 DOI: 10.3390/jcm12103554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/08/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Depression is a significant health problem gaining increasing relevance, especially among children and adolescents. It is known that the incidence of depression is higher in patients suffering from chronic diseases, such as chronic kidney disease (CKD). This review aims to discuss the prevalence of depression in children and adolescents with CKD and its impact on the quality of life of these patients (HRQoL). The research was conducted using online databases with keywords: depression in children and adolescents, depression and chronic diseases, chronic kidney disease, and health-related quality of life. It was found that the risk for developing depression is higher for adolescents and females, and with the use of negative coping strategies, lack of caregiver nurturance, and poor socioeconomic status. In patients with pediatric CKD, the stage of the disease, age of CKD diagnosis, and type of treatment were found to significantly impact HRQoL and contribute to caregiver burden. Depression was more commonly found in children suffering from CKD. It causes significant mental distress to the child and contributes to the caregiver's burden. Screening for depression among CKD patients is advised. In depressed patients, transdiagnostic tools should be used to alleviate some of the symptoms. In children at risk of developing depression, preventative strategies should be considered.
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Affiliation(s)
- Natalia Dryjańska
- Clinical Department of Paediatric Nephrology, University Hospital in Wroclaw, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Katarzyna Kiliś-Pstrusińska
- Clinical Department of Paediatric Nephrology, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
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Courtney DB, Cheung A, Henderson J, Bennett K, Wang W, Chen S, Battaglia M, Strauss J, Mitchell R, Wang K, Relihan J, Prebeg M, Darnay K, Szatmari P. CARIBOU-1: A pilot controlled trial of an Integrated Care Pathway for the treatment of depression in adolescents. JCPP ADVANCES 2022; 2:e12083. [PMID: 37431464 PMCID: PMC10242836 DOI: 10.1002/jcv2.12083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/04/2022] [Indexed: 11/11/2022] Open
Abstract
Background To co-ordinate a multidisciplinary team in the delivery of guideline recommendations using a measurement-based care framework, our group previously developed a care pathway for the treatment of depression in adolescents. Core components of the pathway were: assessment, education, cognitive-behavioural therapy, a caregiver intervention group, a medication algorithm, and monthly measurement-based care "team reviews" with the adolescent present. The aim of this study was to test the feasibility of conducting a controlled clinical trial of the pathway. Method We conducted a 20-week pilot controlled clinical trial of the care pathway relative to treatment as usual. Participants were adolescents (age 14-18) with a primary diagnosis of Major Depressive Disorder recruited from one of two outpatient psychiatric clinics at academic hospitals. Site of presentation was the method of allocation. Thirty-five youth were allocated to the pathway and 31 were allocated to treatment as usual. As this is a pilot study, trial feasibility outcomes were of primary interest, including clinician fidelity to the care pathway. Results Our target sample size was recruited over a 15-month time interval. Clinician fidelity and adolescent engagement in the care pathway components on a priori checklists were high (95% and 80%, respectively). We collected baseline and 20-week endpoint data for our primary outcome of the Children's Depression Rating Scale - Revised (CDRS-R) for 83% of the sample. On linear mixed effects modelling, we observed a linear decrease in CDRS-R across 4-week intervals up to the 20-week endpoint in both groups (β = -2.07; 95% CI -3.14 to -1.01). Conclusion A controlled clinical trial of a complex, multi-component intervention for the treatment of depression in adolescents is feasible. Given the need to find optimal strategies to deliver effective care for adolescents with depression, a definitive randomized controlled trial of the pathway is warranted.Trial is registered at Clinicaltrials.gov: NCT03428555.
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Affiliation(s)
| | - Amy Cheung
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Joanna Henderson
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Kathryn Bennett
- Department of Clinical Epidemology & BiostatisticsMcMaster UniversityHamiltonOntarioCanada
| | - Wei Wang
- Centre for Addiction and Mental HealthTorontoOntarioCanada
| | - Sheng Chen
- Centre for Addiction and Mental HealthTorontoOntarioCanada
| | - Marco Battaglia
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | | | - Rachel Mitchell
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Karen Wang
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Jacqueline Relihan
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental HealthTorontoOntarioCanada
| | - Matthew Prebeg
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental HealthTorontoOntarioCanada
| | | | - Peter Szatmari
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
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Long Q, Jin H, You X, Liu Y, Teng Z, Chen Y, Zhu Y, Zeng Y. Eczema is a shared risk factor for anxiety and depression: A meta-analysis and systematic review. PLoS One 2022; 17:e0263334. [PMID: 35180242 PMCID: PMC8856547 DOI: 10.1371/journal.pone.0263334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/17/2022] [Indexed: 12/18/2022] Open
Abstract
Globally, anxiety and depression are the most common psychiatric disorders that add large burdens to individuals and society; however, the mechanisms underlying these disorders are unclear. Several studies have found that eczema is a shared risk factor for both these conditions. We identified and evaluated eligible observational studies from EMBASE and PubMed. In total, 20 relevant cohort and case-control studies comprising 141,910 patients with eczema and 4,736,222 control participants fulfilled our established criteria. Information extracted included study design, location, sample size, sex distribution of cases and controls or reference cohorts, measurements of outcomes, odds ratio (OR) with 95% confidence interval (CI), and adjusted factors for exposure associated with outcome risk. The meta-analysis was performed by calculating the pooled OR with 95% CI, and heterogeneity was assessed using Cochrane Q and I2 statistics. The pooled effect showed a positive association (n = 4,896,099, OR = 1.63, 95% CI [1.42-1.88], p<0.001) between eczema and depression or anxiety, with positive associations also observed in the depression (n = 4,878,746, OR = 1.64, 95% CI [1.39-1.94], p<0.001) and anxiety (n = 4,607,597, OR = 1.68, 95% CI [1.27-2.21], p<0.001) groups. Subgroup and sensitivity analyses confirmed that these findings were stable and reliable. This study suggests that eczema is associated with an increased risk of developing depression and anxiety, which may assist clinicians in the prevention or treatment of these disorders.
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Affiliation(s)
- Qing Long
- Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China
| | - Hongxia Jin
- Ziyang Hospital of Traditional Chinese Medicine, Ziyang, Sichuan, China
| | - Xu You
- Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China
| | - Yilin Liu
- Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China
| | - Zhaowei Teng
- Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China
- The First People’s Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yatang Chen
- Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China
| | - Yun Zhu
- Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China
- * E-mail: (YZ); (YZ)
| | - Yong Zeng
- Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China
- Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- * E-mail: (YZ); (YZ)
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Complementary and alternative medicine mention and recommendations in guidelines for anxiety: A systematic review and quality assessment. Psychiatry Res 2022; 309:114388. [PMID: 35051879 DOI: 10.1016/j.psychres.2022.114388] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 11/03/2021] [Accepted: 01/08/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Up to 43% of patients with anxiety disorders (ADS) use complementary and alternative medicine (CAM), however, many healthcare providers receive little training on this topic. Clinical practice guidelines (CPGs) are relied upon to guide decision-making, especially with respect to topics less familiar to healthcare providers. In the present study, we identified the quantity and assessed the quality of CAM recommendations in CPGs for the treatment and/or management of ADS. METHODS MEDLINE, EMBASE, and CINAHL were systematically searched from 2009 to April 2020 to identify eligible CPGs. In addition, the Guidelines International Network and the National Center for Complementary and Integrative Health websites were also searched. Eligible CPGs containing CAM recommendations were evaluated using AGREE II. RESULTS Eleven CPGs were eligible, of which six made CAM recommendations. Average scaled domain percentages for these six CPGs from highest to lowest were as follows (% overall, % CAM): clarity and presentation (83.3%, 73.6%); scope and purpose (77.8%, 76.4%); editorial independence (69.4%, 36.8%); stakeholder involvement (55.6%, 31.9%); rigour of development (53.1%, 46.9%); and applicability (43.8%, 29.2%). CONCLUSIONS A need exists to improve the quality of CAM recommendations in anxiety CPGs through insight from AGREE II and other CPG development resources.
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Niu M, Gao Y, Yang M, Zhang Y, Geng J, Song Z, Chen Y, Li Y, Li J, Tian J. The quality and clinical applicability of recommendations in anxiety disorders guidelines: A systematic review of seventeen guidelines from seven countries. J Affect Disord 2021; 295:1301-1309. [PMID: 34706444 DOI: 10.1016/j.jad.2021.08.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/31/2021] [Accepted: 08/28/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anxiety disorders are the most common mental disorders, for which some countries and organizations have developed guidelines. It is necessary to understand the quality of these guidelines. METHODS The relevant guidelines were searched systematically by five reviewers using Appraisal of Guidelines for Research and Evaluation (AGREE) II and AGREE Recommendation Excellence (AGREE-REX) instruments. The scores in each domain were descriptively analyzed, and guidelines from different countries were compared. RESULTS Seventeen guidelines were included. The scores in the domains "rigor of development" and "applicability" were the lowest and ranged from 16% to 77% and 25% to 71%, respectively. The scores in the domains "implementability" and "values and preferences" were similar and ranged from 30% to 67% and 25% to 77%. In terms of the comparison among countries, the Canadian guidelines achieved the highest scores in many domains but only scored 43% in the domain of "values and preferences". The Indian guidelines scored less than 50% in many domains but achieved a high score of 83% in the domain "scope and purpose". LIMITATIONS Language restrictions may cause selection bias. Besides, insufficient reports may lead to deviation of assessment results. CONCLUSIONS There was no obvious advantage in guidelines from different countries. There was still a lot of room for improvement in some domains, especially "applicability", "implementability", "rigor of development" and "values and preferences".
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Affiliation(s)
- Mingming Niu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Min Yang
- Comprehensive Department of Medical Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yonggang Zhang
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Geng
- Department of General Surgery, Second Hospital of Lanzhou University, Lanzhou, China
| | - Ziwei Song
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yamin Chen
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yanchen Li
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Jiang Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jinhui Tian
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China.
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Campisi SC, Krause KR, Chan BWC, Courtney DB, Bennett K, Korczak DJ, Szatmari P. Eating, sleeping and moving recommendations in clinical practice guidelines for paediatric depression: umbrella review. BJPsych Open 2021; 7:e185. [PMID: 34607616 PMCID: PMC8503910 DOI: 10.1192/bjo.2021.1020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Current first-line treatments for paediatric depression demonstrate mild-to-moderate effectiveness. This has spurred a growing body of literature on lifestyle recommendations pertaining to nutrition, sleep and exercise for treating paediatric depression. AIMS Paediatric depression clinical practice guidelines (CPGs) were reviewed for quality and to catalogue recommendations on nutrition, sleep and exercise made by higher-quality CPGs. METHOD Searches were conducted in Medline, EMBASE, PsycINFO, Web of Science and CINAHL, and grey literature CPGs databases for relevant CPGs. Eligible CPGs with a minimum or high-quality level, as determined by the Appraisal of Guidelines for Research and Evaluation, Second Edition instrument, were included if they were (a) paediatric; (b) CPGs, practice parameter or consensus or expert committee recommendations; (c) for depression; (d) the latest version and (e) lifestyle recommendations for nutrition, sleep or exercise. Key information extracted included author(s), language, year of publication, country, the institutional body issuing the CPG, target disorder, age group, lifestyle recommendation and the methods used to determine CPG lifestyle recommendations. RESULTS Ten paediatric CPGs for depression with a minimum or high-quality level contained recommendations on nutrition, sleep or exercise. Lifestyle recommendations were predominately qualitative, with quantitative details only outlined in two CPGs for exercise. Most recommendations were brief general statements, with 50% lacking supporting evidence from the literature. CONCLUSIONS Interest in lifestyle interventions for treatment in child and youth depression is growing. However, current CPG lifestyle recommendations for nutrition, sleep or exercise are based on expert opinion rather than clinical trials.
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Affiliation(s)
- Susan C Campisi
- Department of Psychiatry, Hospital for Sick Children, Canada
| | - Karolin R Krause
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Canada; Evidence-Based Practice Unit, University College London, UK; and Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, UK
| | | | - Darren B Courtney
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Canada; and Department of Psychiatry, University of Toronto, Canada
| | - Kathryn Bennett
- Department of Health Research Methods, Evidence and Impact, McMaster University, Canada
| | - Daphne J Korczak
- Department of Psychiatry, Hospital for Sick Children, Canada; and Department of Psychiatry, University of Toronto, Canada
| | - Peter Szatmari
- Department of Psychiatry, Hospital for Sick Children, Canada; Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Canada; and Department of Psychiatry, University of Toronto, Canada
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The Feedback Session of an Autism Assessment: A Scoping Review of Clinical Practice Guideline Recommendations. J Autism Dev Disord 2021; 52:1821-1840. [PMID: 34036417 PMCID: PMC8148412 DOI: 10.1007/s10803-021-05067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 10/31/2022]
Abstract
This review aimed to assess the quality and content of recommendations for delivering an autism diagnosis, published internationally within clinical practice guidelines. Seventeen relevant guidelines were identified. When methodological information was provided, recommendations for feedback were predominantly formed through consensus. Recommendations consistently included who should attend feedback, the timing and mode of delivery, the clinician's manner, and what should be discussed and/or included in an accompanying report. Specific recommendations were not consistent however, and a number of gaps were identified, such as the inclusion of educators and educational specific recommendations. Although individual variation is necessary for autism diagnosis disclosure, agreement on minimum standards of practice is warranted. Further investigation is required to establish best practice.
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Trepanier L, Reyes A, Stamoulos C, Beauchamp S, Dagenais C, Ciquier G, Drapeau M. Can We Develop Evidence-Based Guidelines Without Research Expertise? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:937-941. [PMID: 33580393 DOI: 10.1007/s10488-021-01110-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 11/25/2022]
Abstract
The development and implementation of clinical practice guidelines has flourished over the past two decades. Unfortunately, many studies have found that the quality of such guidelines is highly variable (Alonso-Coello et al. in Qual Safe Health Care 19:e58, 2010; MacQueen et al. in Can J Psychiatry 62:11-23, 2016); research suggests that some of the guidelines used in psychology have been developed using poor methods for guideline development (Bennett et al. in Depress Anxiety 35:330-340, 2018; Trepanier et al. in: Can Psychol 58: 211-217, 2017). While there remains a dearth of research in this area, typically, it is guidelines themselves that are examined by researchers, while too little attention is paid to the developers, and more specifically to how the guideline development groups are composed and the nature of the expertise of those involved in developing the guidelines. Given the importance of grounding guidelines in science, it is key that guideline development groups be comprised of research experts that will help ensure that this essential aspect be respected. In this brief paper, we provide findings from a recent study in which group composition as well as the expertise of guideline development committee members at the Order of Psychologists of Quebec (OPQ) was examined, as defined by academic research productivity. As results highlighted a clear imbalance between clinical and research expertise in these specific committees, with only a small percentage of researchers being represented, we conclude that major improvements need to be made for research to properly reach practitioners and make recommendations to facilitate this.
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Affiliation(s)
- Lyane Trepanier
- Department of Counselling Psychology, McGill University, 3700 McTavish, Montreal, QC, H3A 1Y2, Canada
| | - Andrea Reyes
- Department of Counselling Psychology, McGill University, 3700 McTavish, Montreal, QC, H3A 1Y2, Canada
| | - Constantina Stamoulos
- Department of Counselling Psychology, McGill University, 3700 McTavish, Montreal, QC, H3A 1Y2, Canada
| | - Sylvie Beauchamp
- Department of Counselling Psychology, McGill University, 3700 McTavish, Montreal, QC, H3A 1Y2, Canada
- Montreal West Island Integrated University Health and Social Services Center, Montreal, QC, Canada
| | | | - Gabrielle Ciquier
- Department of Counselling Psychology, McGill University, 3700 McTavish, Montreal, QC, H3A 1Y2, Canada
| | - Martin Drapeau
- Department of Counselling Psychology, McGill University, 3700 McTavish, Montreal, QC, H3A 1Y2, Canada.
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
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Schmaling K, Kaplan RM, Porzsolt F. Efficacy and effectiveness studies of depression are not well-differentiated in the literature: a systematic review. BMJ Evid Based Med 2021; 26:28-30. [PMID: 32188642 DOI: 10.1136/bmjebm-2020-111337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND In the literature on the treatment of depression, efficacy and effectiveness research have different purposes and should apply different research methodologies. OBJECTIVE The purpose of the study was to review characteristics of depression treatment studies identified using efficacy or effectiveness search terms. We considered subject inclusion and exclusion criteria; numbers of subjects enrolled and the proportion in the primary analyses; inclusion of a Consolidated Standards of Reporting Trials (CONSORT) flow diagram; use of random assignment; use of placebo control conditions; lengths of treatment and follow-up; primary outcome variable; trial registration; journal impact factor. STUDY SELECTION Studies indexed as efficacy AND 'real-world' AND depression or effectiveness AND 'real-world' AND depression in PubMed up to 18 May 2019. FINDINGS 27 studies met the inclusion criteria: 13 effectiveness studies, 6 efficacy studies and 8 studies indexed as both effectiveness and efficacy. Studies identified as effectiveness, efficacy, or both differed on three outcome measures: the inclusion criteria were lengthier for efficacy than for effectiveness studies; efficacy studies were more likely to have a placebo control condition than effectiveness studies; and the journal impact factor was lower for effectiveness studies than for studies from the efficacy search or studies identified by both searches. CONCLUSIONS Efficacy and effectiveness research hypothetically use different methodologies, but the efficacy and effectiveness literatures in the treatment of depression were comparable for most of the coded characteristics. The lack of distinguishable characteristics suggests that variably applied terminology may hinder efforts to narrow the gap between research and practice. PROSPERO REGISTRATION NUMBER: #CRD42019136840.
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Affiliation(s)
- Karen Schmaling
- Psychology, Washington State University, Vancouver, Washington, USA
| | - Robert M Kaplan
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, California, USA
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Ng JY, Nazir Z, Nault H. Complementary and alternative medicine recommendations for depression: a systematic review and assessment of clinical practice guidelines. BMC Complement Med Ther 2020; 20:299. [PMID: 33028320 PMCID: PMC7541317 DOI: 10.1186/s12906-020-03085-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Up to 50% of individuals diagnosed with depression are known to use complementary and alternative medicine (CAM). The aim of this study was to identify the quantity and assess the quality of CAM recommendations in clinical practice guidelines for the treatment and/or management of depression in adults using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. METHODS A systematic review was conducted to identify depression guidelines. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018. The Guidelines International Network and the National Center for Complementary and Integrative Health websites were also searched. Eligible guidelines published by non-profit agencies on treatment of depression for adults were assessed with the AGREE II instrument twice, once for the overall guideline and once for the CAM sections. RESULTS From 931 unique search results, 19 guidelines mentioned CAM, of which 16 made CAM recommendations. Scaled domain percentages from highest to lowest were as follows (overall, CAM section): clarity of presentation (87.0, 66.1%), scope and purpose (80.9, 77.6%), stakeholder involvement (62.0, 44.3%), editorial independence (61.6, 61.6%), rigour of development (58.0, 52.0%), and applicability (42.2, 25.4%). Quality varied within and across guidelines. Only 1 of 16 guidelines was recommended without modifications for both its overall and CAM sections by both appraisers. CONCLUSIONS There are multiple depression guidelines containing CAM recommendations available and there are a comprehensive set of CAM therapy options for depression. The quality of guidelines varied within and across guidelines and the quality of CAM recommendations was generally lower than the overall recommendations in the guidelines for all domains except editorial independence. Generally, characteristics of guidelines, including the year of publication and region of development varied across the guidelines irrespective of quality. Guidelines with higher AGREE II scores can serve as a guide to facilitate communication between patients and medical professionals regarding CAM use for depression, while guidelines with lower scores could be improved in future updates using the AGREE II instrument as a guide.
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Affiliation(s)
- Jeremy Y. Ng
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, MDCL-2112, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Zainib Nazir
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, MDCL-2112, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Hayley Nault
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, MDCL-2112, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
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15
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Courtney D, Bennett K, Henderson J, Darnay K, Battaglia M, Strauss J, Watson P, Szatmari P. A Way through the woods: Development of an integrated care pathway for adolescents with depression. Early Interv Psychiatry 2020; 14:486-494. [PMID: 31883210 DOI: 10.1111/eip.12918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/14/2019] [Indexed: 01/02/2023]
Abstract
AIMS Depression in adolescents is common and debilitating. Treatment approaches vary widely across clinics and may not reflect evidence-based care. Integrated care pathways (ICPs) are implementation tools to facilitate bridging the gap between rigorous but often complex clinical practice guidelines and what is actually practiced. We describe the development of an ICP for the treatment of Adolescents with Major Depressive Disorder (MDD-A) based on the best-available clinical practice guidelines and derived in collaboration with clinicians, administrators, youth partners and caregivers. METHODS With clinician and health service manager input, we took the recommendations from a high quality clinical practice guideline (the National Institute of Health and Care Excellence Clinical Practice Guideline for Depression in Children and Young People) and translated them into an ICP. Feedback from youth partners and clinicians was iteratively incorporated into the current version of the pathway using a collaborative approach. RESULTS The current iteration of the pathway at a Canadian tertiary care teaching hospital is described. All youth (and caregivers, if applicable) are offered a multi-family psychoeducation session, a 16-session Group Cognitive Behaviour Therapy and team reviews every 4 weeks that include measurement-based care. Conditional branches of the pathway include a medication algorithm and an 8-session group for caregivers. CONCLUSIONS The resulting ICP provides a tool to facilitate bridging the gap between evidence and clinical practice.
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Affiliation(s)
- Darren Courtney
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn Bennett
- McMaster University, Department of Health Research Methods, Evidence and Impact. Hamilton, Ontario, Canada
| | - Joanna Henderson
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Karleigh Darnay
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Marco Battaglia
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - John Strauss
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Priya Watson
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Peter Szatmari
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
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Westergren T, Narum S, Klemp M. Adverse effects information in clinical guidelines on pharmacological treatment of depression in children and adolescents: a systematic review. BMJ Open 2020; 10:e036412. [PMID: 32690742 PMCID: PMC7375629 DOI: 10.1136/bmjopen-2019-036412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To analyse to what extent clinical practice guidelines on drug treatment of depression in children and adolescents mention the risk of adverse effects, to characterise the citations in the guidelines and to assess to what extent data from a major study (Treatment for Adolescents With Depression Study, TADS) was used as basis for information about adverse effects. DESIGN Systematic review of clinical guidelines and clinical decision support tools. DATA SOURCES PubMed, EMBASE, guideline collections, Health libraries. ELIGIBILITY CRITERIA We included national guidelines on depression in children and adolescents from European and/or English-speaking countries, published in English, German, French or any Scandinavian language since 2008. We also included well-known, international clinical decision support tools. DATA EXTRACTION AND SYNTHESIS Guidelines were examined by all authors to identify and classify information on adverse effects. Citations for statements on adverse effects were extracted and classified by category. The extent of citations about suicidality risk versus other adverse effects was assessed. RESULTS 19 guidelines were assessed. All guidelines discussed risk of suicidal behaviour connected with use of antidepressants. Most guidelines mentioned some other psychiatric adverse effects. Several guidelines did not include information on well-known and common somatic adverse effects. Most references concerned risk of suicidality. Adverse effects identified in underlying studies were not always presented. The TADS study was referred to, directly or indirectly, by 18/19 guidelines, but some only referred to TADS with regard to suicidality without citing the study's findings of somatic adverse effects. No guideline commented on the lack of long-term adverse effects data from TADS. CONCLUSIONS Guidelines for treatment of depression in children and adolescents vary widely regarding information on adverse effects. Many guidelines do not provide information on common somatic adverse effects. There is no consensus as to what extent risks of adverse effects connected with use of antidepressants should be described in guidelines.
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Affiliation(s)
- Tone Westergren
- Regional Medicines Information and Pharmacovigilance Centre (RELIS Sør-Øst), Dept. of Pharmacology, Oslo University Hospital, Oslo, Norway
- Dept. of Pharmacology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sigrid Narum
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| | - Marianne Klemp
- Dept. of Pharmacology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Boylan K, MacQueen G, Kirkpatrick R, Lee J, Santaguida PL. A systematic review of interventions for treatment resistant major depressive disorder in adolescents. Eur Child Adolesc Psychiatry 2020; 29:433-443. [PMID: 31165921 DOI: 10.1007/s00787-019-01341-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/19/2019] [Indexed: 12/24/2022]
Abstract
To update a comparative effectiveness review (1980-2011) of treatments for adolescents whose depressive episode or disorder (MDE/MDD) did not respond to one or more trials of SSRI antidepressants. MEDLINE, Cochrane Central, PsychINFO, Cochrane Database of Systematic Reviews, EMBASE, CINAHL, and AMED were searched in addition to the grey literature. We spanned May 2011 to September 1, 2017 and included only articles in English. 11 new studies were reviewed based on the criteria of having tested a comparative treatment in adolescents with MDD or MDE who were confirmed to have failed one or more SSRI trials. Data were extracted using standardized forms and a reference guide in DistillerSR; a second reviewer verified the accuracy of the data fields and discrepancies were resolved by consensus. One trial (N = 29) found a small benefit of escalating doses of fluoxetine and the treatment of adolescent depression study (TORDIA, N = 334) found significant benefits of combined SSRI or venlafaxine treatment with CBT for most outcomes. No new studies were identified since the previous review (2012). One trial is currently registered that will be a cross over trial of rTMS; other registered trials are open label. Multiple secondary data analyses of TORDIA have identified important predictors of treatment response and relapse. No new comparative studies were identified since the original review. Trials are desperately needed to identify new treatments for youth with SSRI resistant MDD. These youth should not be deemed as treatment resistant until completing one or two failed trials of SSRI combined with evidence-based psychotherapy.
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Affiliation(s)
- Khrista Boylan
- McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada.
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Watson P, Mehra K, Hawke LD, Henderson J. Service provision for depressed children and youth: a survey of the scope and nature of services in Ontario. BMC Health Serv Res 2019; 19:947. [PMID: 31818284 PMCID: PMC6902427 DOI: 10.1186/s12913-019-4784-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/26/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The worldwide prevalence of depressive disorders among children and youth has been reported in ranges from just under 3% to over 10%. In Canada, 7% of youth report past year depression, which is higher than any other age demographic. Yet, many of these youth do not receive evidence based interventions, increasing their risk for serious lifetime consequences. To better understand low service use, it is crucial to map and evaluate current services. This study aimed to determine the scope and nature of services available to depressed children and youth, and compare services to best evidence treatment guidelines. METHODS Several government and non-government resources were utilized to develop a new multi-sectoral database of depression services for children and youth across Ontario. An online survey was sent to program managers serving children/youth with depression, examining agency characteristics, populations served, services provided, patterns of service use, evaluation activities, and research priorities. RESULTS 413 agencies with 869 program managers participated, representing mental health, addictions and other sectors. Age groups served included children up to 12 years of age (31%), adolescents aged 13-17 (70%) and transition aged youth (18-25 years) (81%). Over half of respondents worked in the mental health (43.4%) or mental health and addiction (24.4%) sectors. The most frequently provided services were assessment, psychotherapy, case management, and psychoeducation; the most common types of psychotherapy provided included cognitive behavioral therapy, social skills training, and solution-focused therapy. Psychotherapies are offered in widely varying formats, frequencies and durations. Discontinuation rates varied, with higher discontinuation among transition aged youth as compared to children. Respondents identified effective treatment, improving access, and reducing service gaps as top future research priorities. CONCLUSIONS This study provides important new data on service provision and uptake for depressed children and youth. Comparing these results with best-evidence practice guidelines raises significant concerns about the services most commonly offered and their delivery formats. In addition, high early discontinuation rates raise questions about the service experiences of children, youth and their families. Other factors which may contribute to ongoing treatment engagement challenges include access barriers, service or client characteristics, and unintentional treatment impacts.
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Affiliation(s)
- Priya Watson
- Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
| | - Kamna Mehra
- Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | - Lisa D Hawke
- Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | - Joanna Henderson
- Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
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Rose K, Neubauer D, Grant-Kels JM. Too Many Avoidable Suicides Occur Worldwide in Young Patients. Rambam Maimonides Med J 2019; 10:RMMJ.10374. [PMID: 31545703 PMCID: PMC6824826 DOI: 10.5041/rmmj.10374] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
United States (US) and European Union (EU) laws attempt to counterbalance the presumed discrimination of children in drug treatment and drug development. The US Food and Drug Administration (FDA)-rewarded pediatric studies with antidepressants triggered in 2004 an FDA black-box warning of suicidality in young patients. Fewer antidepressants were prescribed, and the number of completed suicides of young persons increased. The dilemma between this warning and the need to adequately treat young depressed patients remains unsolved. We analyzed the history of drug development, the evolving view of diseases in young patients, US/EU pediatric laws, and pediatric studies triggered by FDA/European Medicines Agency (EMA) in depression and other diseases on the background of developmental pharmacology; financial, institutional, and other interests; and the literature. The FDA/EMA define children administratively, not physiologically, as <17 (FDA)/<18 years old (EMA). But young persons mature physiologically well before their 17th/18th birthday. Depression occurs in young persons, has special characteristics, but is not fundamentally different from adult depression. Young persons are not another species. Regulatory requirements for "pediatric" studies focus on "pediatric" labels. Many "pediatric" studies, including those in depression, lacked and lack medical sense and harm patients by placebo treatment although effective drugs exist. The FDA has partially abandoned separate "pediatric" efficacy studies, but not in psychiatry. Clinicians, parents, institutional review boards, and ethics committees should become aware of questionable "pediatric" studies, should re-evaluate ongoing ones, consider to suspend them, and to reject new ones. The concept of separate "pediatric" drug approval needs to be abandoned.
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Affiliation(s)
- Klaus Rose
- klausrose Consulting, Pediatric Drug Development & More, Riehen, Switzerland
- To whom correspondence should be addressed: E-mail:
| | - David Neubauer
- Department of Child, Adolescent and Developmental Neurology, University Children’s Hospital, Ljubljana, Slovenia
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Middleton JC, Kalogeropoulos C, Middleton JA, Drapeau M. Assessing the methodological quality of the Canadian Psychiatric Association's anxiety and depression clinical practice guidelines. J Eval Clin Pract 2019; 25:613-621. [PMID: 30295980 DOI: 10.1111/jep.13026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 01/09/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Clinical practice guidelines (CPGs) endeavour to incorporate the best available research evidence together with the clinically informed opinions of leading experts in order to guide clinical practice when dealing with a given condition. There has been increased interest in CPGs that are evidence based and that promote best practice, a central component of which is incorporating the best available research predicated on strong study designs. Despite this soaring interest, there remains heterogeneity in the methodological quality of many CPGs, which may have an effect on the quality of services that clinicians offer. In light of this, this study examined the quality of the methodology used to develop two CPGs of the Canadian Psychiatric Association (CPA). METHOD The CPA's guidelines for the management of anxiety disorders (2006) and for the treatment of depressive disorders (2001) were assessed by trained raters using the Appraisal of Guidelines for Research and Evaluation II Instrument scale. RESULTS The blind ratings of three trained raters demonstrated that the anxiety and depression CPGs had a number of strengths and important weaknesses. CONCLUSION Implications for the development of future CPGs on anxiety and depression, including recommendations to improve guideline quality in psychiatry in particular, are discussed.
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Affiliation(s)
- Jerry C Middleton
- Graduate Students, Counselling Psychology, McGill University, Montréal, Québec, Canada
| | | | - Jason A Middleton
- Graduate Students, Counselling Psychology, McGill University, Montréal, Québec, Canada
| | - Martin Drapeau
- Associate Professor, Counselling Psychology and Psychiatry, McGill University, Montréal, Québec, Canada
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21
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Zafra-Tanaka JH, Goicochea-Lugo S, Villarreal-Zegarra D, Taype-Rondan A. Characteristics and quality of clinical practice guidelines for depression in adults: a scoping review. BMC Psychiatry 2019; 19:76. [PMID: 30786870 PMCID: PMC6381686 DOI: 10.1186/s12888-019-2057-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 02/12/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Clinical 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. METHODS We 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. RESULTS We 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. CONCLUSIONS Most 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.
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Affiliation(s)
| | | | - David Villarreal-Zegarra
- Universidad Peruana Cayetano Heredia, CRONICAS Centre of Excellence for Chronic Diseases, Lima, Peru
- Instituto Peruano de Orientación Psicológica, Lima, Peru
| | - Alvaro Taype-Rondan
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Av. La Fontana 550, La Molina, Lima, Peru
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Courtney DB, Bennett K, Szatmari P. The Forest and the Trees: Evidence-Based Medicine in the Age of Information. J Am Acad Child Adolesc Psychiatry 2019; 58:8-15. [PMID: 30577942 DOI: 10.1016/j.jaac.2018.06.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/22/2018] [Accepted: 08/15/2018] [Indexed: 01/08/2023]
Abstract
In 2005, John Hamilton2 wrote in the Journal on how best to practice evidence-based medicine, namely develop an answerable question from a clinical situation and then work your way down a hierarchy of evidence to identify the best available evidence to inform your clinical decision. He advised formulating each clinical question requiring the use of evidence as population, intervention, comparison, outcome, and timing (PICOT). Actually, Hamilton referred to PECOT, where "E" stands for "exposure," but we prefer the acronym Haynes et al.3 used. For Alyssa's query, the question would be, "Among adolescents with depression (P), is venlafaxine (I) more effective than placebo (C) in decreasing depressive symptoms (O) after 12 weeks (T)?" In this Translations article, we set out to answer the question, "What approach is currently recommended for clinicians searching for high-quality evidence to guide optimal clinical decision making?" When Hamilton wrote his piece, he focused on individual randomized controlled trials as the primary source of good evidence. However, in 2018, given the amount of information available, it has become increasingly clear that it is more helpful and efficient to start with high-quality evidence syntheses of primary studies (ie, systematic reviews [SRs], meta-analyses [MAs], and clinical practice guidelines [CPGs]) rather than with the individual primary studies. This means that clinicians now need to become versed in how to distinguish a high-quality synthesis from low-quality ones.
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