Original Title: Herramientas de ayuda para la toma de decisiones de los pacientes con depresión

Authors' objectives: 1. To conduct a systematic review (SR) to identify all DAs available for patients suffering from depression and to create an inventory. 2. To complete a SR of DAs’ effectiveness and SDM process for patients with depression, analysing outcomes, and assessing their effectiveness and impact, as well on different health outcomes.

Authors' results and conclusions: RESULTS: A total of 3902 references were considered after the elimination of duplicates; 115 were assessed in full-text for possible inclusion. Seven articles were eventually included: 2 clinical trials reported in six articles (the first one reported in: Ludman 2000, Katon 2001, Simon 2002, Ludmer 2003, Von Korff 2003; and the second one in: Loh 2007) and an observational study (Wills 2003) that does not evaluate an intervention, but evaluates the level of satisfaction with the decision-making process in patients with depression. Participants from studies included, RCT as well as the observational study, were mostly women (74.8%). The age range was between 31 to 50 years. In the two RCT, it was evaluated two multifaceted programs based on concepts of shared decision making. In both studies, participants in control group received care as usual intervention. Regarding the quality assessment, the score of the two RCTs included was 2 according to the Jadad scale. The RCTs included in this revision lost two points because patients and practitioners could not be blinded to this type of intervention. The OS (Wills 2003), obtained a total score of 16 on 26 points (Estabrooks scale). Results evaluated were grouped into the following categories: depressive symptoms and level of severity, decision-making process (satisfaction, participation and decisional conflict), treatment adherence and other outcomes. As far as depressive symptoms one RCT (Ludman 2000, Katon 2001, Simon 2002, Ludman 2003, and von Korff 2003) reported lower scores for depressive symptoms in the control group, although these differences were marginal at both the clinical and statistical level. In the second RCT study (Loh 2007) there was not found a statistically significant reduction in the severity of depression between groups. Regarding to the decisional process, evidence shows (Loh, 2007) that the DA improves patients’ satisfaction and participation in the decisional process in the intervention group participants. In the observational study (Wills 2003) it was found that a low satisfaction with the decision was associated with less patient involvement on the decision making process about the treatment. In addition, it was found that bigger decisional conflict was associated with low satisfaction. On the other hand, regarding treatment adherence, differences were only obtained after carrying out the intervention in one of the RCT (Ludman 2000, Katon 2001, Simon 2002, Ludman 2003, and Von Korff 2003). In the OS (Wills 2003), the satisfaction was associated with the self-informed use of antidepressant medication. The results showed that patients who rejected the antidepressant drug had a significantly lower satisfaction with their primary care centre, a higher decisional conflict, and reported a preference for greater control in making decisions about their medication, compared with patients who had started the medication. Furthermore, patients who discontinued the medication reported significantly higher levels of decisional conflict on the decision making about antidepressant drug. CONCLUSIONS: From the results obtained in this revision, we can observed that, in comparison with other health fields in healthcare, research into DAs on depression is at a very early stage. Furthermore, the majority of the literature on SDM process and depression have been focused on assessing the role of physicians in the decisional process and not the effect of DAs itself. The evidence shows that DAs on depression improve satisfaction and patients’ participation in the decisional process. However, there is no evidence on satisfaction with the decision made or the therapeutic option chosen. Furthermore, we do not have enough information to know whether patients have increased their knowledge about depression. Future research is needed to identify decision-making variables which play a central role in mental health as well as the validation of measuring instruments for the particularities of mental health care, especially depression. Likewise, it is necessary to conduct primarystudies which evaluate the effects of DAs in patients with depression. These DAs might be multifaceted, with more than one session, and with a multidisciplinary team trained.

Project Status: Completed

Year Published: 2010

URL for published report: https://sescs.es/herramientas-de-ayuda-para-la-toma-de-decisiones-de-los-pacientes-con-depresion/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Canary Health Service

Contact Address: Dirección del Servicio. Servicio Canario de la Salud, Camino Candelaria 44, 1ª planta, 38109 El Rosario, Santa Cruz de Tenerife

Contact Name: sescs@sescs.es

Contact Email: sescs@sescs.es