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National Collaborating Centre for Mental Health (UK). Common Mental Health Disorders: Identification and Pathways to Care. Leicester (UK): British Psychological Society (UK); 2011. (NICE Clinical Guidelines, No. 123.)

Cover of Common Mental Health Disorders

Common Mental Health Disorders: Identification and Pathways to Care.

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APPENDIX 5REVIEW PROTOCOLS

Access to healthcare

Clinical review protocol for the review of models of service delivery

ComponentDescription
Review questionIn adults (18 years and older) at risk of depression or anxiety disorders* (in particular BME groups and older people), what factors prevent people accessing mental healthcare services?
ObjectivesTo perform a narrative synthesis of the evidence that assesses and identifies potential factors affecting access to mental healthcare services.
Subquestions
  • What factors, or attributes of the individual who requires mental healthcare, can inhibit access to services?
  • What practitioner-level factors or attributes can inhibit an individual from accessing healthcare?
  • Do systems and processes utilised in mental healthcare services inhibit access to healthcare?
  • What practical or resource-based factors inhibit access to mental healthcare services?
PopulationAdults (18 years and older) identified as at risk of depression or anxiety disorders.*
Intervention(s)Not applicable
ComparisonNot applicable
Critical outcomesIdentified factors affecting access
Electronic databasesSystematic reviews: CDSR, CINAHL, DARE, EMBASE, MEDLINE, PsycINFO
RCTs: CENTRAL
Date searchedSystematic reviews: 1 January 1995 to 10 September 2010
RCTs: 1 January 2004 to 10 September 2010
Study designSystematic review and RCT
*

Including GAD, panic disorder, social anxiety disorder, OCD, specific phobias, and PTSD.

Clinical review protocol for the review of models of service delivery

ComponentDescription
Review questionIn adults (18 years and older) at risk of depression or anxiety disorders* (in particular older people and people from ethnic minorities), do changes to specific models of service delivery (that is, community based outreach clinics, clinics or services in non-health settings), increase the proportion of people from the target group who access treatment, when compared with standard care?
ObjectivesTo perform a narrative synthesis of the evidence, which assesses the effectiveness of adapting or changing existing models, methods, services and interventions, with the aim of improving access to healthcare.
SubquestionsDo adaptations to existing services improve access to mental healthcare for all individuals?
Do adaptations improve access to mental healthcare for vulnerable groups (for example, older people, BME groups)?
PopulationAdults (18 years and older) identified as at risk of depression or anxiety disorders*(in particular, older people and people from BME groups
Intervention(s)
  • Service developments or changes which are specifically designed to promote access.
  • Specific models of service delivery (that is, community-based outreach clinics, clinics or services in non-health settings).
  • Methods designed to remove barriers to access (including stigma (both cultural and self and stigmatisation), misinformation or cultural beliefs about the nature of mental disorder).
Comparison
  • Standard care
Critical outcomes
  • Proportion of people from the target group who access treatment
  • Uptake of treatment
Secondary outcomes
  • Satisfaction, preference
  • Anxiety about treatment
Electronic databasesSystematic reviews: CDSR, CINAHL, DARE, EMBASE, MEDLINE, PsycINFO
RCTs: CENTRAL
Date searchedSystematic reviews: 1 January 1995 to 10 September 2010
RCTs: 1 January 2004 to 10 September 2010
Study designSystematic review and RCT
*

Including GAD, panic disorder, social anxiety disorder, OCD, specific phobias and PTSD.

Clinical review protocol for the review of service developments

ComponentDescription
Review questionIn adults (18 years and older) at risk of depression or anxiety disorders* (in particular, older people and people from ethnic minorities), do service developments which are specifically designed to promote access, increase the proportion of people from the target group who access treatment, when compared with standard care?
ObjectivesTo perform a narrative synthesis of the evidence which assesses the effectiveness of service developments which are specifically designed to promote access.
Subquestions
  • Do new service developments targeted at changing the behaviour of the individual or the practitioner improve access to healthcare services?
  • Do service developments targeted at the healthcare system improve access to healthcare services?
  • Do specific treatments or interventions developed for vulnerable groups improve access to healthcare services?
PopulationAdults (18 years and older) identified as at risk ofdepression or anxiety disorders* (in particular, older people and people from ethnic minorities)
Intervention(s)
  • Service developments which are specifically designed to promote access
  • Specific models of service delivery (that is, community based outreach clinics, clinics or services in non-healthcare settings)
Comparison
  • Standard care
Critical outcomes
  • Proportion of people from the target group who access treatment
  • Uptake of treatment
Secondary outcomes
  • Satisfaction, preference
  • Anxiety about treatment
  • Individual/Practitioner Communication
Electronic databasesSystematic reviews: CDSR, CINAHL, DARE, EMBASE, MEDLINE, PsycINFO
RCTs: CENTRAL
Date searchedSystematic reviews: 1 January 1995 to 10 September 2010
RCTs: 01 January 2004 to 10 September 2010
Study designSystematic review and RCT
*

Including GAD, panic disorder, social anxiety disorder, OCD, specific phobias and PTSD.

Case identification

Clinical review protocol for the review of case identification tools

ComponentDescription
Review question(s)
  1. In adults (18 years and older) with a suspected anxiety disorder at first point of contact, what ultra-brief identification tools (1 to 3 items) when compared with a gold standard diagnosis (based on DSM or ICD criteria) improve identification (that is, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic OR) of people with an anxiety disorder?
  2. In adults (18 years and older) with a suspected anxiety disorder at first point of contact, what longer identification tools (4to 12 items) when compared with agold standard diagnosis (based on DSM or ICD criteria) improve identification (that is, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic OR) of people with an anxiety disorder?
ObjectivesTo determine whether there are any case identification instruments that could be recommended for use in primary care.
PopulationAdults (18 years and older)
Intervention(s)Case identification instruments (≤12 items)
ComparisonDSM or ICD diagnosis of anxiety or GAD
Critical outcomesSensitivity, specificity, positive predictive value, negative predictive value, AUC
Electronic databasesEMBASE, MEDLINE, CINAHL, PsycINFO
Date searchedInception to 10 September 2010
Study designCross-sectional

Clinical review protocol for the review of assessment tools and methods for the delivery of assessments

ComponentDescription
Review questionIn adults (18 years and older) identified with depression (including subthreshold disorders) or an anxiety disorder*, what is the clinical utility of more formal assessments of the nature and severity of common mental health disorder (including problem specification or diagnosis) when compared with another management strategy?
ObjectivesTo perform a narrative synthesis of NICE guidelines and systematic reviews.
PopulationAdults (18 years and older) identified with depression (including subthreshold disorders) or an anxiety disorder*
Intervention(s)Formal assessments of the nature and severity of common mental health disorder (including problem specification or diagnosis)
ComparisonAnother management strategy
Critical outcomesClinical utility
Electronic databasesSystematic reviews: CDSR, CINAHL, DARE, EMBASE, MEDLINE, PsycINFO
RCTs: CENTRAL
Date searchedSystematic reviews: 1 January 1995 to 10 September 2010
RCTs: 1 January 2008 to 10 September 2010
Study designSystematic reviews and RCTs
*

Including GAD, panic disorder, social anxiety disorder, OCD, specific phobias and PTSD.

Assessment

Clinical review protocol for the review of risk assessment

ComponentDescription
Review questionIn adults (18 years and older) identified with depression (including subthreshold disorders) or an anxiety disorder*, what is the definition, delivery and value (or otherwise) of risk assessment?
ObjectivesTo perform a narrative synthesis of existing NICE guidelines and systematic reviews addressing risk assessment for people with common mental health disorder.
PopulationAdults (18 years and older) identified with depression (including subthreshold disorders) or an anxiety disorder*
Intervention(s)Risk assessment
ComparisonStandard management strategy
Critical outcomesClinical utility
Electronic databasesSystematic reviews: CDSR, CINAHL, DARE, EMBASE, MEDLINE, PsycINFO
RCTs: CENTRAL
Date searchedSystematic reviews: 1 January 1995 to 10 September 2010
RCTs: 1 January 2008 to 10 September 2010
Study designSystematic review and RCTs
*

Including GAD, panic disorder, social anxiety disorder, OCD, specific phobias and PTSD.

Clinical review protocol for the review of predictors of response

ComponentDescription
Review questionIn adults (18 years and older) identified with depression (including subthreshold disorders) or an anxiety disorder*, what factors predict treatment response and/or treatment failure?
ObjectivesTo perform a narrative synthesis of existing NICE guidelines and published systematic reviews addressing treatment response factors for people with common mental health disorder.
PopulationAdults (18 years and older) identified with depression (including subthreshold disorders) or an anxiety disorder*
Intervention(s)Not applicable
ComparisonNot applicable
Critical outcomesAssociation between predictor and treatment response/ failure
Electronic databasesSystematic reviews: CDSR, CINAHL, DARE, EMBASE, MEDLINE, PsycINFO
Date searched1 January 2003 to 10 January 2011
Study designNICE guidelines, systematic reviews
*

Including GAD, panic disorder, social anxiety disorder, OCD, specific phobias, and PTSD.

Clinical review protocol for the review of routine outcome monitoring

ComponentDescription
Review questionIn adults (18 years and older) identified with depression (including subthreshold disorders) or an anxiety disorder*, should ROM be used, and if so, what systems are effective for the delivery of ROM and use within clinical decision making?
ObjectivesTo perform a narrative synthesis of systematic reviews addressing the use of ROM for people with common mental health disorder.
PopulationAdults (18 years and older) identified with depression (including subthreshold disorders) or an anxiety disorder*
Intervention(s)ROM, systems for the delivery of ROM
ComparisonStandard management strategy
Critical outcomescommon mental health disorder symptoms, duration of treatment
Electronic databasesSystematic reviews CDSR, CINAHL, DARE, EMBASE, MEDLINE, PsycINFO
RCTs: CENTRAL
Date searchedSystematic reviews: 1 January 1995 to 10 September 2010
RCTs: 1 January 1995 to 10 September 2010
Study designSystematic review and RCTs
*

Including GAD, panic disorder, social anxiety disorder, OCD, specific phobias, and PTSD.

Systems for organising and developing local care pathways

Clinical review protocol for the review of routine outcome monitoring

ComponentDescription
Review questionIn adults (18 years and older) with depression (including subthreshold disorders) or an anxiety disorder*, what are the specific components of a good care pathway?
ObjectivesTo conduct a narrative synthesis of existing systematic reviews to establish the specific components of a good care pathway.
PopulationAdults (18 years and older) identified with depression (including subthreshold disorders) or an anxiety disorder*
Intervention(s)Not applicable
ComparisonNot applicable
Critical outcomesNot applicable
Electronic databasesCDSR, CINAHL, DARE, EMBASE, MEDLINE, PsycINFO
Date searched1 January 1995 to 10 September 2010
Study designSystematic review
*

Including GAD, panic disorder, social anxiety disorder, OCD, specific phobias, and PTSD.

Copyright © 2011, The British Psychological Society & The Royal College of Psychiatrists.

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.

Bookshelf ID: NBK92253
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