Hegarty Kelsey, Gunn Jane, Blashki Grant, Griffiths Frances, Dowell Tony, Kendrick Tony
Primary Care Research Unit, Department of General Practice, University of Melbourne, Victoria, Australia.
Br J Gen Pract. 2009 May;59(562):e149-56. doi: 10.3399/bjgp09X420581.
Many guidelines have been developed in the area of depression but there has been no systematic assessment of their relevance to general practice.
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.
Review of national guidelines.
Seven English speaking countries: UK, US, Australia, New Zealand, Ireland, Canada, and Singapore.
Seven guidelines were independently reviewed quantitatively using the Appraisal of Guidelines for Research and Evaluation (AGREE) scores and qualitatively using thematic coding.
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.
Assessments of current national guidelines on depression management in general practice suggest significant limitations in their relevance to general practice.
抑郁症领域已制定了许多指南，但尚未对其与全科医疗的相关性进行系统评估。
采用两种互补方法评估抑郁症全科医疗管理的国家指南，以确定可使指南与全科医疗性质及在此背景下寻求帮助的患者更相关且适用的具体方式。
对国家指南进行综述。
七个英语国家：英国、美国、澳大利亚、新西兰、爱尔兰、加拿大和新加坡。
使用研究与评价指南评估（AGREE）评分对七项指南进行独立定量综述，并使用主题编码进行定性综述。
定量评估突出显示，大多数指南未达到制定的严谨性、适用性和编辑独立性标准。定性评估表明，大多数指南未充分涉及相关风险因素，诊断不确定性的困境延续到管理建议中。所有指南都支持抑郁症的管理策略（抗抑郁药和心理策略），其中几项在心理治疗之前列出了药物；对不同类型的心理治疗关注有限。此外，这些指南总体上未能考虑个体患者情况，特别是诸如不良生活事件或社会支持等社会问题对治疗反应的影响。
对当前抑郁症全科医疗管理国家指南的评估表明，它们与全科医疗的相关性存在重大局限性。
