How could depression guidelines be made more relevant and applicable to primary care?


Hegarty, Kelsey, Gunn, Jane, Blashki, Grant, Griffiths, Frances, Dowell, Tony and Kendrick, Tony (2009) How could depression guidelines be made more relevant and applicable to primary care? British Journal of General Practice, 59, (562), e149-e156. (doi:10.3399/bjgp09X420581).

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Original Publication URL: http://dx.doi.org/10.3399/bjgp09X420581

Description/Abstract

Background

Many guidelines have been developed in the area of depression but there has been no systematic assessment of their relevance to general practice.

Aim

To assess national guidelines on general practice management of depression using two complementary approaches to identify specific ways in which guidance could be made more relevant and applicable to the nature of general practice and the patients who seek help in this context.

Design of study

Review of national guidelines.

Setting

Seven English speaking countries: UK, US, Australia, New Zealand, Ireland, Canada, and Singapore.

Method

Seven guidelines were independently reviewed quantitatively using the Appraisal of Guidelines for Research and Evaluation (AGREE) scores and qualitatively using thematic coding.

Results

The quantitative assessment highlights that most of the guidelines fail to meet the criteria on rigour of development, applicability, and editorial independence. The qualitative assessment shows that the majority of guidelines do not address associated risk factors sufficiently and the dilemma of diagnostic uncertainty flows over into management recommendations. Management strategies for depression (antidepressants and psychological strategies) are supported by all of the guidelines, with several listing drugs before psychological therapies; there is limited attention paid to the different types of psychological therapies. Moreover, the guidelines in the main fail to acknowledge individual patient circumstances, in particular the influence on response to treatment of social issues such as adverse life events or social support.

Conclusion

Assessments of current national guidelines on depression management in general practice suggest significant limitations in their relevance to general practice.

Item Type: Article
ISSNs: 0960-1643 (print)
Related URLs:
Keywords: appraisal, depression, guidelines
Subjects: R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
R Medicine > RM Therapeutics. Pharmacology
R Medicine > RA Public aspects of medicine
Divisions: University Structure - Pre August 2011 > School of Medicine > Community Clinical Sciences
ePrint ID: 68823
Date Deposited: 06 Oct 2009
Last Modified: 27 Mar 2014 18:48
Contact Email Address: ark1@soton.ac.uk
URI: http://eprints.soton.ac.uk/id/eprint/68823

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