Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Depress Anxiety. 2018 Jun;35(6):530-540. doi: 10.1002/da.22752. Epub 2018 Apr 26.
Little is known about the trustworthiness of clinical practice guidelines (PGs) relevant to child and youth depression or anxiety. To address this gap, we used systematic review methods to identify all available relevant PGs, quality appraise them, and make recommendations regarding which PGs are trustworthy and should be used by clinicians.
Prespecified inclusion criteria identified eligible PGs. Two independent trained reviewers applied the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Using three AGREE II domain scores (stakeholder involvement, rigor of development [clinical validity/trustworthiness], and editorial independence), PG quality was designated as (1) minimum (≥50%) and (2) high (≥70%).
Of 25 eligible PGs, five met minimum quality criteria (depression, n = 4; anxiety, n = 1); three out of five met high-quality criteria (depression, n = 2; anxiety, n = 1). Among the five minimum quality PGs, developers included government (n = 2), independent expert groups (n = 2), and other (n = 1). No PGs developed by specialty societies achieved minimum or high-quality ratings; eight of 25 PGs were up-to-date.
Trustworthy PGs are available to support clinical decisions about depression and anxiety in children and youth, but are few in number. Many existing PGs (up to 80%) may not be clinically valid. Clinicians who implement the high-quality PGs identified here can increase the number of children and youth who receive effective interventions for depression and anxiety, minimize harm, and avoid wasted resources. Clinicians, service planners, youth, and their families should encourage PG developers to increase the pool of high-quality PGs using internationally recognized PG development standards.
关于儿童和青少年抑郁或焦虑的临床实践指南（PGs）的可信度知之甚少。为了弥补这一空白，我们使用系统评价方法来确定所有可用的相关 PGs，对其进行质量评估，并就哪些 PGs 是值得信赖的，应该由临床医生使用提出建议。
预设的纳入标准确定了合格的 PGs。两名独立的经过培训的审查员应用评估指南研究与评价（AGREE II）工具。使用 AGREE II 三个领域的评分（利益相关者参与、开发的严谨性[临床有效性/可信度]和编辑独立性），PG 质量被指定为（1）最低（≥50%）和（2）高（≥70%）。
在 25 项合格的 PGs 中，有 5 项符合最低质量标准（抑郁，n=4；焦虑，n=1）；其中 3 项符合高质量标准（抑郁，n=2；焦虑，n=1）。在 5 项最低质量的 PGs 中，开发者包括政府（n=2）、独立专家组（n=2）和其他（n=1）。没有一个由专业协会制定的 PGs 达到最低或高质量评级；25 项 PGs 中有 8 项是最新的。
有值得信赖的 PGs 可用于支持儿童和青少年抑郁和焦虑的临床决策，但数量较少。许多现有的 PGs（高达 80%）可能没有临床有效性。实施这里确定的高质量 PGs 的临床医生可以增加接受有效干预抑郁和焦虑的儿童和青少年的数量，减少伤害，并避免浪费资源。临床医生、服务规划者、青少年及其家属应鼓励 PG 开发者使用国际公认的 PG 开发标准来增加高质量 PG 的数量。
