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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. 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?

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  1. The NICE Depression Guidelines and the recovery model: is there an evidence base for IAPT? Susan McPherson Chris Evans Phil Richardson

  2. 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

  3. 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?

  4. 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

  5. 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Trials Trials of psychological treatment for depression included in NICE review N=49 Excluded: 3x German language 1x unpublished N=45 (100%) n=28 (62%) Trials using non-symptom measures Trials using QOL/functioning measures n=20 (44%) Trials reporting QOL/F outcomes n=12 (27%)

  6. QOL/functioning measures (2/12 studies present analysis of 2 measures >>> 14 effects reviews)

  7. Results Continued…

  8. Results (Continued) 1significance not tested but DP did not have treatment effect, PS did

  9. 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

  10. 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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