Published in News
Researchers have published a systematic review addressing disparities in the development and implementation of guidelines for managing depression in low- and middle-income countries.
More than 50 collaborators across 30 countries have published a systematic review in the World Health Organisation Bulletin, which addresses the disparities in the development and implementation of guidelines for managing depression in low- and middle-income countries (LMICs).
With depression becoming increasingly prevalent worldwide, and the disease burden disproportionately affecting LMICs, it is vital that clinical practice guidelines (CPGs) translate the latest research into recommendations that are effective in improving health outcomes and reducing morbidity and mortality.
The GACD Mental Health Guidelines Working Group, led by Yena Lee and Dr Roger McIntyre at the University of Toronto, aimed to characterise the development and implementation of CPGs for managing major depressive disorder and bipolar disorder.
They also compared CPGs from high-income countries (HICs) with LMICs to assess how readily available guidelines were, and the quality of the process of developing guidelines. They also examined at how easily translatable and implementable the guidelines were, as well as how easy they were to monitor.
The global team of researchers examined 94 national and international CPGs in 26 languages across 82 countries. Concerningly, the team reported that many LMICs, particularly in Africa, lack any CPGs, with only one low-income country having any guidelines at all.
Key findings included:
81 per cent of CPGs target psychiatrists, but only 20 per cent target policymakers.
Of the 57 guidelines that provided recommendations related to depression, six (10 per cent) recommended against depression screening.
Just a quarter (26 per cent) of all CPGs for depression were developed by a multidisciplinary team, compared to two thirds (64 per cent) in diabetes mellitus.
Clarity of guidelines in LMICs was just 33%, compared to 76% in HICs.
No LMIC guidelines had been subject to systematic or external reviews.
Only half (54 per cent) of guidelines openly declared funding sources and conflicts of interest.
The group concluded that globally, guideline implementation is inadequately planned, reported and measured. In order to narrow the disparities in development and implementation of guidelines across LMICs, it is vital that these differences are urgently addressed.
In LMICs particularly, the decision support process in depression is a critical first step towards reducing morbidity, and so it is vital that this healthcare professionals can equip patients with the tools they need at this early stage. Further analysis is required to ensure that CPGs are acceptable to patients who will ultimately benefit from them, and to ensure cost-effectiveness.
If we are to be effective in tackling depression globally, future guidelines must set out strategies on how to implement recommendations and measure feasibility. They must be determined cost-effective, have a demonstrable impact on health outcomes, and must be co-designed by stakeholders and experts from LMICs.