Depression in Adults with a Chronic Physical Health Problem

422 Pages·2010·2.21 MB·English

by  National Collaborating Centre for Mental Health

Depression in
adults with a
chronic physical
health problem
THE NICE GUIDELINE ON TREATMENT
AND MANAGEMENT
1954.qxd 30/11/10 8:22 PM Page 1
DEPRESSION
IN ADULTS
WITH A CHRONIC
PHYSICAL HEALTH
PROBLEM
TREATMENT AND MANAGEMENT
National Clinical Practice Guideline 91
National Collaborating Centre for Mental Health
commissioned by the
National Institute for Health &
Clinical Excellence
published by
The British Psychological Society and The Royal College of
Psychiatrists
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© The British Psychological Society
& The Royal College of Psychiatrists, 2010
The views presented in this book do not necessarily reflect those of the British
Psychological Society, and the publishers are not responsible for any error of
omission or fact. The British Psychological Society is a registered charity
(no. 229642).
All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in any
information storage or retrieval system, without permission in writing from
the publishers. Enquiries in this regard should be directed to the British
Psychological Society.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from
the British Library.
ISBN-: 978-1-904671-86-2
Printed in Great Britain by Stanley L. Hunt (Printers) Ltd.
Additional material: data CD-Rom created by Pix18
(www.pix18.co.uk)
developed by National Collaborating Centre for Mental Health
The Royal College of Psychiatrists
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21 Mansell Street
London
E1 8AA
www.nccmh.org.uk
commissioned by National Institute for Health and Clinical Excellence
MidCity Place, 71 High Holborn
London
WCIV 6NA
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published by The British Psychological Society
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and
The Royal College of Psychiatrists
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London
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www.rcpsych.ac.uk
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Contents
CONTENTS
GUIDELINE DEVELOPMENT GROUP MEMBERS 6
ACKNOWLEDGEMENTS 8
1 PREFACE 9
1.1 National guidelines 9
1.2 The national guideline on depression in adults with a
chronic physical health problem 12
2 DEPRESSION IN ADULTS WITH A CHRONIC
PHYSICAL HEALTH PROBLEM 15
2.1 Introduction 15
2.2 Depression in adults with a chronic physical health problem 15
2.3 The reciprocal relationship between depression and chronic
physical health problems 23
2.4 Consequences of depression in adults with a chronic physical
health problem 25
2.5 The economic cost of depression in adults with a chronic
physical health problem 27
3 METHODS USED TO DEVELOP THIS GUIDELINE 29
3.1 Overview 29
3.2 The scope 29
3.3 The Guideline Development Group 30
3.4 Clinical questions 32
3.5 Systematic clinical literature review 33
3.6 Health economics methods 45
3.7 Methods for reviewing experience of care 48
3.8 Stakeholder contributions 49
3.9 Validation of the guideline 49
4 EXPERIENCE OF CARE 50
4.1 Introduction 50
4.2 Personal accounts 50
4.3 Qualitative analysis of the experience of care for people
with a chronic physical health problem 55
4.4 A qualitative analysis of the experience of care for families
and carers of people with a chronic physical health problem 65
4.5 Review of the qualitative literature 67
4.6 Summary of themes 74
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Contents
4.7 From evidence to recommendations 76
4.8 Recommendations 76
5 THE IDENTIFICATION OF DEPRESSION IN PEOPLE
WITH A CHRONIC PHYSICAL HEALTH PROBLEM 78
5.1 Introduction 78
5.2 Methods for detecting depression 78
5.3 Case identification in black and minority ethnic populations 90
5.4 Overall summary 96
5.5 From evidence to recommendations 96
5.6 Recommendations 97
6 SERVICE-LEVEL INTERVENTIONS FOR PEOPLE
WITH DEPRESSION AND A CHRONIC PHYSICAL
HEALTH PROBLEM 101
6.1 Introduction 101
6.2 Current practice and aims of the review 104
6.3 Stepped care 105
6.4 Service-level interventions 110
6.5 Economic modelling: cost effectiveness of collaborative care
for people with depression and a chronic physical health problem 130
6.6 From evidence to recommendations 153
6.7 Recommendations 154
6.8 Research recommendations 154
7 PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS
FOR PEOPLE WITH DEPRESSION AND A CHRONIC
PHYSICAL HEALTH PROBLEM 157
7.1 Introduction 157
7.2 Review of clinical evidence for psychological and psychosocial
interventions 163
7.3 Health economic evidence for psychological and psychosocial
interventions 200
7.4 From evidence to recommendations 206
7.5 Recommendations 208
7.6 Research recommendations 212
8 PHARMACOLOGICAL INTERVENTIONS IN THE
TREATMENT AND MANAGEMENT OF DEPRESSION
IN ADULTS WITH A CHRONIC PHYSICAL
HEALTH PROBLEM 215
8.1 Introduction 215
8.2 Efficacy of pharmacological interventions 215
8.3 Adverse effects of pharmacological interventions 241
8.4 Interactions between medications for treating physical
health problems and antidepressants 251
8.5 Antidepressant discontinuation symptoms 255
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Contents
8.6 Health economic evidence 257
8.7 Overall summary on efficacy, safety, adverse effects and
interactions, and economic evidence 260
8.8 From evidence to recommendations 260
8.9 Recommendations 261
8.10 Research recommendations 267
9 SUMMARY OF RECOMMENDATIONS 269
9.1 Care of all people with depression 269
9.2 Stepped care 272
9.3 Step 1: recognition, assessment and initial management in
primary care and general hospital settings 272
9.4 Step 2: recognised depression in primary care and general
hospital settings – persistent subthreshold depressive or mild
to moderate depression 274
9.5 Step 3: recognised depression in primary care and general
hospital settings – persistent subthreshold depressive symptoms
or mild to moderate depression with inadequate response to
initial interventions, and moderate and severe depression 277
9.6 Step 4: complex and severe depression 284
9.7 Research recommendations 284
10 APPENDICES 289
11 REFERENCES 390
12 ABBREVIATIONS 414
5
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Guideline Development Group members
GUIDELINE DEVELOPMENT GROUP MEMBERS
Professor Sir David Goldberg (Chair, Guideline Development Group)
Professor Emeritus, Institute of Psychiatry, King’s College London
Professor Stephen Pilling (Facilitator, Guideline Development Group)
Director, National Collaborating Centre for Mental Health
Director, Centre for Outcomes Research and Effectiveness, University College
London
Dr Neil Andrews
Consultant Cardiologist and Electrophysiologist, Portsmouth NHS Hospital Trust
Ms Victoria Bird
Research Assistant, National Collaborating Centre for Mental Health
Professor Francis Creed
Professor of Psychological Medicine, University of Manchester
Professor Christopher Dowrick
Professor of Primary Medical Care, University of Liverpool
Mr Matthew Dyer
Health Economist, National Collaborating Centre for Mental Health
Dr Gwyneth Grout
Consultant Nurse (until May 2008), Mental Health Liaison (Older People),
Hampshire Partnership NHS Trust
Dr Mark Haddad
Clinical Research Fellow, Health Service and Population Research Department,
Institute of Psychiatry
Dr John Hindle
Consultant Physician Care of the Elderly, Clinical Director of Medicine, North West
Wales NHS Trust
Dr David Kessler
Walport Clinical Lecturer – Primary Care, Bristol University
Ms Katherine Leggett
Project Manager (from 2008), National Collaborating Centre for Mental Health
Ms Angela Lewis
Research Assistant, National Collaborating Centre for Mental Health
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Guideline Development Group members
Mr Ryan Li
Project Manager (until 2008), National Collaborating Centre for Mental Health
Professor James Lindesay
Professor of Psychiatry for the Elderly, University of Leicester
Dr Nicholas Meader
Systematic Reviewer, National Collaborating Centre for Mental Health
Ms Margaret Ogden
Service User Member
Dr Suffiya Omarjee
Health Economist, National Collaborating Centre for Mental Health
Dr Jonathan Packham
Consultant Rheumatologist, Haywood Hospital
Senior Lecturer, Primary Care Musculoskeletal Research Centre, Arthritis Research
Campaign National Primary Care Centre, Keele University
Dr Catherine Pettinari
Project Manager (until 2008), National Collaborating Centre for Mental Health
Ms Maria Rizzo
Research Assistant, National Collaborating Centre for Mental Health
Mr Rob Saunders
Research Assistant (from 2008), National Collaborating Centre for Mental Health
Ms Sarah Stockton
Senior Information Scientist, National Collaborating Centre for Mental Health
Dr Clare Taylor
Editor, National Collaborating Centre for Mental Health
Professor David Taylor
Chief Pharmacist, South London and Maudsley NHS Trust
Professor of Psychopharmacology, King’s College London
Dr Veronica (Nicky) Thomas
Consultant Health Psychologist, Guy’s and St. Thomas’ NHS Foundation Trust
Honorary Lecturer, Department of Psychology, Institute of Psychiatry, King’s
College London
Mr Steve Wilcox
Head of Occupational Therapy, Specialist Services Directorate, Leeds Partnership
NHS Foundation Trust for Mental Health and Learning Disabilities
Honorary Senior Lecturer, Academic Unit of Primary Care, University of Leeds
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Acknowledgements
ACKNOWLEDGEMENTS
The Guideline Development Group would like to thank the following:
Service user and carer accounts
Healthtalkonline for allowing the use of material from their website.
Editorial assistance
Ms Nuala Ernest
Ms Marie Halton
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Preface
1 PREFACE
This guideline provides the evidence for the management of depression in adults with
a chronic physical health problem. Another guideline on depression was also devel-
oped at the same time, which was an update of the 2004 depression guideline (NICE,
2004a; NCCMH, 2004). Some of the work undertaken for this guideline on depres-
sion in adults with a chronic physical health problem was carried out jointly with the
update of the depression guideline (NICE, 2009; NCCMH, 2010), therefore some of
the evidence is reproduced in both guidelines.
1.1 NATIONAL GUIDELINES
1.1.1 What are clinical practice guidelines?
Clinical practice guidelines are ‘systematically developed statements that assist clini-
cians and patients in making decisions about appropriate treatment for specific condi-
tions’ (Mann, 1996). They are derived from the best available research evidence,
using predetermined and systematic methods to identify and evaluate the evidence
relating to the specific condition in question. Where evidence is lacking, the guide-
lines incorporate statements and recommendations based upon the consensus state-
ments developed by the Guideline Development Group (GDG).
Clinical guidelines are intended to improve the process and outcomes of health-
care in a number of different ways. They can:
● provide up-to-date evidence-based recommendations for the management of condi-
tions and disorders by healthcare professionals
● be used as the basis to set standards to assess the practice of healthcare professionals
● form the basis for education and training of healthcare professionals
● assist service users and their carers in making informed decisions about their treat-
ment and care
● improve communication between healthcare professionals, service users and their
carers
● help identify priority areas for further research.
1.1.2 Uses and limitations of clinical guidelines
Guidelines are not a substitute for professional knowledge and clinical judgement. They
can be limited in their usefulness and applicability by a number of different factors: the
availability of high-quality research evidence, the quality of the methodology used in
the development of the guideline, the generalisability of research findings and the
uniqueness of individuals with depression and a chronic physical health problem.
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