How could depression guidelines be made more relevant and applicable to primary care? A quantitative and qualitative review of national guidelines

Background Many guidelines have been developed in the area of depression but there has been no systematic assessment of their relevance to general practice. Aim To assess national guidelines on general practice management of depression using two complementary approaches to identify specific ways in which guidance could be made more relevant and applicable to the nature of general practice and the patients who seek help in this context. Design of study Review of national guidelines. Setting Seven English speaking countries: UK, US, Australia, New Zealand, Ireland, Canada, and Singapore. Method Seven guidelines were independently reviewed quantitatively using the Appraisal of Guidelines for Research and Evaluation (AGREE) scores and qualitatively using thematic coding. Results The quantitative assessment highlights that most of the guidelines fail to meet the criteria on rigour of development, applicability, and editorial independence. The qualitative assessment shows that the majority of guidelines do not address associated risk factors sufficiently and the dilemma of diagnostic uncertainty flows over into management recommendations. Management strategies for depression (antidepressants and psychological strategies) are supported by all of the guidelines, with several listing drugs before psychological therapies; there is limited attention paid to the different types of psychological therapies. Moreover, the guidelines in the main fail to acknowledge individual patient circumstances, in particular the influence on response to treatment of social issues such as adverse life events or social support. Conclusion Assessments of current national guidelines on depression management in general practice suggest significant limitations in their relevance to general practice.