A summary of selected new evidence from the UK’s National Institute for Health and Clinical Evidence (NICE)

Last month, NICE released an update of selected new evidence for common mental health disorders.

The update identifies new evidence from the period of September 1, 2010 to October 15, 2012 that is relevant to the Common Mental Health Disorders clinical guideline (NICE clinical guideline 123), issued in May 2011. Practitioners who support clients with mental health challenges may be interested in some of the key points highlighted in the update.

The following table outlines key points from the report along with the populations affected:

Population Evidence Regarding Identification and Assessment
Women within one year of a live birth Asking two general case-finding questions about depression may be useful for identifying or ruling out postnatal depression:‘During the last month, have you often been bothered by feeling down, depressed or hopeless?’ and ‘During the last month, have you often been bothered by having little interest or pleasure in doing things?’ (1)
People with learning disabilities Generally, instruments for identifying anxiety and depression in people with learning disabilities seem to be insufficiently studied, although the Glasgow Anxiety Scale for people with an Intellectual Disability (GAS-ID), the Anxiety Depression and Mood Scale (ADAMS) and the Glasgow Depression Scale for people with a Learning Disability (GAS-LD) may be useful.The authors concluded that the Glasgow Anxiety Scale for people with an Intellectual Disability (GAS-ID) was the most promising self-reported instrument. (2)
Individuals in primary care General Practitioners (GPs) may correctly rule out distress and depression in about 80% of people who do not have distress or depression; however GPs may only diagnose distress correctly in about half of people with distress and may only diagnose depression correctly in about a third of people who have depression.Clinicians who are not competent to perform mental health assessments should refer people with possible common mental health disorders to appropriate healthcare professionals. (3)
Older individuals in primary care The 15-item Geriatric Depression Scale (GDS) may be useful in primary care for diagnosing depression. (4)
Individuals with common mental health disorders The Patient Health Questionnaire (PHQ)-9 is a useful instrument for diagnosing depression and using a diagnostic cut-off score of 10 may have increased sensitivity in primary care compared with hospital settings. (5)
Evidence Regarding Treatment and Referral for Treatment
People with acquired physical disabilities Evidence for telephone counselling in people with acquired physical disabilities seems to be limited, but may indicate beneficial effects on coping strategies, community integration and depression. (6)

The complete evidence update can be found here. Please note that evidence updates do not replace current accredited guidance and do not provide formal practice recommendations.

Additional evidence updates from NICE, listed by specialty, are located here.

A database of NICE’s published clinical guidelines can be found here.

 

Key References

  1. Mann R, Gilbody S (2011) Validity of two case finding questions to detect postnatal depression: a review of diagnostic test accuracy. Journal of Affective Disorders 133: 388–97
  2. Hermans H, van der Pas FH, Evenhuis HM (2011) Instruments assessing anxiety in adults with intellectual disabilities: a systematic review. Research in Developmental Disabilities 32: 861–70. Hermans H, Evenhuis HM (2010) Characteristics of instruments screening for depression in adults with intellectual disabilities: systematic review. Research in Developmental Disabilities 31: 1109–20
  3. Mitchell AJ, Rao S, Vaze A (2011) Can general practitioners identify people with distress and mild depression? A meta-analysis of clinical accuracy. Journal of Affective Disorders 130: 26–36
  4. Mitchell AJ, Bird V, Rizzo M et al. (2010) Diagnostic validity and added value of the geriatric depression scale for depression in primary care: a meta-analysis of GDS30 and GDS15. Journal of Affective Disorders 125:10–17
  5. Manea L, Gilbody S, McMillan D (2012) Optimal cut-off score for diagnosing depression with the patient health questionnaire (PHQ-9): a meta-analysis. CMAJ 184: DOI:10.1503/cmaj.110829
  6. Dorstyn DS, Mathias JL, Denson LA (2011) Psychosocial outcomes of telephone-based counseling for adults with an acquired physical disability: a meta-analysis. Rehabilitation Psychology 56: 1–14