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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

Social/economic costs of depression

Recovery model

Quality of life/work

NICE Depression 2004

Efficacy of  treatment depression

Symptom model

BDI, HRSD

Background: IAPT
slide3
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?
slide4
Aim

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

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Excluded: 3x German language 1x unpublished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

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

results
Results

Continued…

results continued
Results (Continued)

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

results summary
Results Summary
  • 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
  • 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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