How could depression guidelines be made more relevant and applicable to primary care? A quantitative and qualitative review of national guidelines

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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.

Data sourced from Thomson Reuters' Web of Knowledge

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