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The NICE Depression Guidelines and the recovery model: is there an evidence base for IAPT?. Susan McPherson Chris Evans Phil Richardson. Layard – happiness Social/economic costs of depression Recovery model Quality of life/work. NICE Depression 2004 Efficacy of  treatment depression

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The nice depression guidelines and the recovery model is there an evidence base for iapt

The NICE Depression Guidelines and the recovery model: is there an evidence base for IAPT?

Susan McPherson

Chris Evans

Phil Richardson


Background iapt

Layard – happiness there an evidence base for IAPT?

Social/economic costs of depression

Recovery model

Quality of life/work

NICE Depression 2004

Efficacy of  treatment depression

Symptom model

BDI, HRSD

Background: IAPT


Is a symptom oriented systematic review the appropriate evidence base for mounting a programme carrying significant investment (£170 million over 3 years) with the expectation that the investment would be returned through savings in disability benefits?


Aim evidence base for mounting a programme carrying significant investment (£170 million over 3 years) with the expectation that the investment would be returned through savings in disability benefits?

To re-examine the studies reviewed by NICE in the systematic review of psychological treatments for depression (NICE 2004) to identify what information it provides about the effectiveness of psychological treatments in terms of quality of life and functioning indicators


Nice depression guideline trials
NICE Depression Guideline: Trials evidence base for mounting a programme carrying significant investment (£170 million over 3 years) with the expectation that the investment would be returned through savings in disability benefits?

Trials of psychological treatment for depression included in NICE review

N=49

Excluded: 3x German language 1x unpublished

N=45 (100%)

n=28 (62%)

Trials using non-symptom measures

Trials using QOL/functioning measures

n=20 (44%)

Trials reporting QOL/F outcomes

n=12 (27%)


Qol functioning measures
QOL/functioning measures evidence base for mounting a programme carrying significant investment (£170 million over 3 years) with the expectation that the investment would be returned through savings in disability benefits?

(2/12 studies present analysis of 2 measures >>> 14 effects reviews)


Results
Results evidence base for mounting a programme carrying significant investment (£170 million over 3 years) with the expectation that the investment would be returned through savings in disability benefits?

Continued…


Results continued
Results (Continued) evidence base for mounting a programme carrying significant investment (£170 million over 3 years) with the expectation that the investment would be returned through savings in disability benefits?

1significance not tested but DP did not have treatment effect, PS did


Results summary
Results Summary evidence base for mounting a programme carrying significant investment (£170 million over 3 years) with the expectation that the investment would be returned through savings in disability benefits?

  • Most groups improve over time

  • 5 effects show no group difference (equivalence) on symptoms and QOL

  • Remaining 8 effects show group superiority on either symptoms (S), QOL (Q) or both:

1One effect showed CBT to be inferior rather than equivalent


Discussion
Discussion evidence base for mounting a programme carrying significant investment (£170 million over 3 years) with the expectation that the investment would be returned through savings in disability benefits?

  • Equating QOL/F measures to recovery glosses over conceptual issues, but

  • IAPT emphasises recovery, functioning, disability

  • Its evidence base (NICE) emphasises symptoms

  • IAPT concluded an advantage for CBT and IPT

  • Re-examination of the evidence base for QOL outcomes seems to indicate:

    • The QOL evidence base is very limited

    • In what exists, advantages of CBT and IPT are reduced or absent

  • QOL measures need more validation, use and reporting


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