Dizet Sophie, Haffen Emmanuel, Javelot Hervé
Franche-Comté University UMR 1322 LINC, F-25030 Besançon, France, Expert Centre in Psychopharmacology, Sevrey Public Mental Health Hospital (EPSM71), Sevrey, 71100, France.
Clinical Psychiatry Department and CIC-1431 INSERM, Franche-Comté University UMR 1322 LINC, Besançon University Hospital, Besançon, F-25030 , France.
BMC Psychiatry. 2025 Aug 27;25(1):825. doi: 10.1186/s12888-025-07192-6.
Depression is a common mental disorder that has a profound impact on daily life and increases the risk of chronic diseases and mortality. Adherence to treatment guidelines would produce better patient outcomes but is often suboptimal. The objective of this systematic review was to examine adherence to evidence-based treatment guidelines for depression, identify factors that influence adherence and understand how to improve it.
We searched the PubMed, Web of Science and Cochrane databases. We included original trials, studies dealing with treatment-related guidelines and patients suffering from depressive disorders. We excluded reviews, study protocols and studies that dealt exclusively with mental disorders other than depression.
85 studies met the inclusion criteria. Six studies focused on young subjects, three on the perinatal population and three on the elderly. A few studies concerned a population with somatic (n = 11) or psychiatric (n = 25) comorbidities. Eight articles focused on ethnic minorities.
The lack of standard measurement on adherence and the variability in adherence rates highlight the complexity of assessing and implementing guideline-concordant care, and the associated challenges. Factors that influence adherence, such as those related to patients and their comorbidities, physicians, and guideline-related factors, play a significant role in determining whether appropriate treatment is received. Despite the complexity and cost of these strategies, multifaceted approach to guideline implementation, including the active involvement of clinicians, ongoing monitoring, and organisational support, improves guideline adherence.
This review provides a comprehensive overview of the current state of guideline adherence in treatment of depression and identifies areas for quality improvement initiatives.
抑郁症是一种常见的精神障碍，对日常生活有深远影响，并增加了患慢性病和死亡的风险。遵循治疗指南会产生更好的患者治疗效果，但往往不尽人意。本系统评价的目的是研究对抑郁症循证治疗指南的遵循情况，确定影响遵循的因素，并了解如何改善遵循情况。
我们检索了PubMed、科学网和考克兰数据库。我们纳入了原始试验、涉及治疗相关指南的研究以及患有抑郁症的患者。我们排除了综述、研究方案以及专门涉及除抑郁症以外的其他精神障碍的研究。
85项研究符合纳入标准。6项研究关注年轻受试者，3项关注围产期人群，3项关注老年人。少数研究涉及患有躯体合并症（n = 11）或精神合并症（n = 25）的人群。8篇文章关注少数民族。
缺乏对遵循情况的标准测量以及遵循率的变异性凸显了评估和实施符合指南的护理的复杂性以及相关挑战。影响遵循的因素，如与患者及其合并症、医生以及指南相关的因素，在确定是否接受适当治疗方面起着重要作用。尽管这些策略复杂且成本高昂，但多方面的指南实施方法，包括临床医生的积极参与、持续监测和组织支持，可提高对指南的遵循。
本综述全面概述了抑郁症治疗中指南遵循的现状，并确定了质量改进举措的领域。
