Development |
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Devised/adapted | Panel of experts | Working group | Panel of experts | Working group, summary | Broad working group | Broad working group | Panel of experts |
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Conflicts of interest stated | Yes | No | No | Yes | No | Yes | No |
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Consumer/GP input | Both | Both | GP | Not stated | Both | GP | GP |
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Diagnosis |
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Population to be screened | Not stated | High-risk groups | High-risk groups | High-risk groups | High-risk groups | All patients | Not stated |
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Definition | Mild/moderate/severe | DSM-IV classification | DSM-IV type symptoms | Depressive symptoms SIGECAPS and DSM-IV | ICD-10 mild versus moderate and severe | Depressive symptoms SIGECAPS and DSM-IV | Depressive symptoms SIGECAPS and DSM-IV |
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Use of instruments recommended | HAM-D, CES-D | HAM-D, EPDS, BDI, CES-D | BDI-II, HAM-D Prime MD, EPDS | PHQ-9 | None | PHQ-9, BDI, and HAM-D, GDS | HAM-D, HADS, MADRS, BDI, CES-D, CDI |
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Social risk factors outlined | Mentioned | Discusses risk factors including life events and partner abuse | Brief list of risk factors, not partner partner abuse | No | Brief mention of physical state, living conditions, social isolation | Lists risk factors including partner partner abuse | Lists life situations including abuses |
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Demographic risk factors outlined | Not featured | Emphasis on cultural issues, women, sexual orientation, and older groups | Brief mention of age, sex | Subtypes of depression, seasonal, postpartum | Not specifically | Subtypes atypical, seasonal, postpartum | Women, atypical, children and older people |
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Comorbidity | Psychiatric | Psychiatric substance abuse, and physical | Psychiatric and physical | Physical | Physical | Psychiatric, substance abuse, and physical | Psychiatric, physical, and iatrogenic |
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Phase of illness | Yes | Yes | Not in detail | No | Yes | Yes | Yes, figure included |
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Management |
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Treatment: order in which presented | Education, lifestyle, psychological (PST for mild), drugs for moderate | Education, lifestyle, problem solving, drugs and psychological (CBT, IPT), specialist treatment, (lithium, ECT) | Drugs and refer for psychological treatment | Self-management, bibliotherpay, exercise diary psychological (CBT, IPT, PST) drugs | Waiting, sleep, exercise, self-help, befriending, psychological (PST CBT), and drugs for moderate | Education, exercise, psychological drugs | Education, psychological (CBT, IPT, psychodynamic PST, couple therapy), ECT |
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Treatment determined by severity | Yes | Yes | Yes | No | Yes | Yes | Yes |
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Specific drugs | TCA or SSRI | TCA or SSRI | SSRI | SSRI first-line; TCA second-line | SSRI | SSRI or TCA | TCA or SSRI |
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Side-effects | Briefly mentioned | No | Detailed table | Yes | Yes | Detailed side-effect tables | No detail |
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Length of treatment | First episode 1 year; recurrent at least 2 years | First episode 9 months; recurrent 3 years | 6–12 months | First episode 9 months 6 months after remission); recurrent at 2 years | 6 months after remission; recurrent at least 2 years | At least 6 months | 6 months after remission; recurrent as long as necessary |
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Suicide risk discussed | Briefly mentions | Detailed risk-assessment guide | Mentions | Provides checklist | Mentions | Provides checklist | Provides checklist |
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Recommends enlisting social support | Mentions | Mentions involving family | Mentions gaining a history from family/friend | Brief mention of need for social network | Brief mention | Not specifically | Mentions involving family |
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Patient centredness |
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Doctor–patient relationship | Importance of ‘therapeutic alliance’ | Mentions ‘therapeutic relationship’ | No | Mentioned | Alluded to | Alluded to | No |
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Patient choice/engagement | Mentions | Emphasises consumer understanding of options and choice | No | Yes, for example, patient preference for psychological treatment should be considered | Yes | Mentioned | Brief mention |
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Self-management | No | Recommends a number of self-help books | List of organizations given | Recommend bibliotherapy | Self-help groups | No | No |
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System of care |
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Multiprofessional care | Yes | Yes | Yes | Yes | Stepped care model | Yes | No |
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Structured plan | Yes | Yes | Not explicit | Chronic disease management registries and recall and flow sheets and audit | Yes, care plans | Yes | Not explicit |
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Enhanced communication, referral/linkages | Yes | Coordinated approach and detailed indications for referral | Indications for referral listed | Yes | Need for shared care approach | Communication between GP and specialist | Specifies indications for referral |
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Follow-up | Emphasises | Emphasises regular follow-up | Recommends ongoing review | Detailed plan for follow-up | Mentions | Emphasises documented follow-up | Tools for follow-up |
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Cost | No | Yes, costs to patient considered | No | Cost per day of drugs | Referral to document on cost implications for England | Yes, costs to patient mentioned briefly | No |
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Training of doctor needed | Yes | Yes | No | Yes, for example need for supervision of doctors | Mentions need for high standard of consultation skills | No | Self-assessment questionnaire on the guidelines |