Common Mental Disorders Depression - New Zealand Doctor

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Appendix B: Evidence and recommendation grading system Details of the grading system The evidence was assessed and graded, and recommendations were developed using the three-step process described in the New Zealand Guidelines Group (NZGG) Handbook for the Preparation of Explicit Evidence-Based Clinical Practice Guidelines. 574 Step 1: Study appraisal Studies that met the inclusion criteria for each clinical question were appraised and graded for quality, using relevant checklists developed by the Scottish Intercollegiate Guidelines Network (SIGN). 575 These were modified to incorporate summary levels of evidence for the validity, magnitude/precision of effect and applicability of each study. An overall summary level of evidence was assigned to each study, as follows: + assigned when all or most of validity criteria met ~ assigned when some of criteria met and where unmet criteria are not likely to affect the validity, magnitude/precision or applicability of the results markedly x assigned when few or none of the criteria met. Intermediate grades (+/~, ~/x) were assigned when overall study quality fell between these categories. Studies that met few or none of the quality criteria were excluded. For every study included in our evidence review, the level of evidence assigned is listed alongside the citation in the reference list at the end of the guideline. Step 2: Weighing the evidence Evidence tables were prepared for each clinical question and were summarised on considered judgment forms. 574 The Guideline Development Team (GDT) considered the body of evidence and made recommendations, based on the validity, quantity, consistency and clinical impact of the whole body of evidence. Step 3: Developing recommendations Grading of the recommendations was based on the quality of the evidence, which does not equate to the importance of the recommendation. When there was no evidence to answer a specific question, recommendations were based on the consensus of the GDT and were classified as ‘Good Practice Points’. The NZGG Grading System is outlined below (see Grading of Recommendations). 134 Identification of Common Mental Disorders and Management of Depression in Primary Care
Appendix B Evidence and recommendation grading system Grading of recommendations Recommendations The recommendation is supported by good evidence (based on a number of studies that are valid, consistent, applicable and clinically relevant) The recommendation is supported by fair evidence (based on studies that are valid, but there are some concerns about the volume, consistency, applicability and clinical relevance of the evidence that may cause some uncertainty but are not likely to be overturned by other evidence) The recommendation is supported by international expert opinion Grades indicate the strength of the supporting evidence rather than the importance of the evidence A B C Good practice points Where no evidence is available, best practice recommendations are made based on the experience of the Guideline Development Team, or feedback from consultation within New Zealand Identification of Common Mental Disorders and Management of Depression in Primary Care 135
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Identification of Common Mental Dis
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Statement of intent Evidence-based
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Endorsements Te Ao Maramatanga New
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3.6 Clinical features of common men
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List of figures 3.1 When to refer a
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About the guideline Foreword The Ne
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About the guideline Guideline devel
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About the guideline Paediatric subg
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About the guideline Royal New Zeala
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Algorithm 1 Management of depressio
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Algorithm 2a Management of severe d
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Algorithm 2c Management of mild dep
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• limited access to psychiatrists
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Asian peoples About 7% of the New Z
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12-month period amongst adults atte
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Table 1.2 Prevalence of common ment
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1.4 Etiology of common mental disor
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The ‘hopelessness theory’ 94 co
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Sexuality Data from the Christchurc
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Since those who are affected by sui
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2.3 Managing depression: the steppe
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to informed consent. 152 There is a
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3 Recognition and assessment of com
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Chapter 3 Recognition and assessmen
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Good practice points Management of
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Box 4.1 Whänau Ora The concept of
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If the young person/rangatahi/tamar
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Exercise There was insufficient evi
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at any timepoint. Treatment as usua
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5 Recognition and assessment of com
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6 Management of depression in adult
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Chapter 6 Management of depression
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Page 120 and 121: during pregnancy, of which up to 6%
Page 122 and 123: Secondary care evidence Based on ev
Page 124 and 125: Advice for women It may be helpful
Page 126 and 127: Social networks appear to be an inf
Page 128 and 129: eastfeeding, or not breastfeeding,
Page 130 and 131: This evidence comprised two recent
Page 132 and 133: There is also some evidence that th
Page 135 and 136: 8 Special issues: older adults/ kor
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Page 145 and 146: 9 Models of care 9.1 Introduction V
Page 147 and 148: Chapter 9 Models of care were reduc
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Page 156 and 157: NZGG has been funded to develop sum
Page 158 and 159: Appendix A: Guideline development p
Page 162 and 163: Appendix C: Assessment of suicide r
Page 164 and 165: Appendix D: Assessment tools for co
Page 166 and 167: Anxiety Anxiety is often comorbid w
Page 168 and 169: Appendix F: Self-management resourc
Page 170 and 171: Information about mental disorders
Page 172 and 173: Dysthymia Dysthymia is a chronic lo
Page 175 and 176: Glossary, abbreviations and acronym
Page 181 and 182: References 1. The MaGPIe Research G
Page 183 and 184: References 38. Tse S, Tong K, Hong
Page 185 and 186: References 72. Kendler K, Kuhn J, P
Page 187 and 188: References 107. Halligan SL, Murray
Page 189 and 190: References 143. Dejesus RS, Vickers
Page 191 and 192: References 179. Shaffer D, Scott M,
Page 193 and 194: References 215. Garralda ME, Bowman
Page 195 and 196: References 249. Zwaanswijk M, Verha
Page 197 and 198: References 283. Linde K, Berner M,
Page 199 and 200: References 318. Henkel V, Mergl R,
Page 201 and 202: References 353. Rush AJ. STAR*D: wh
Page 203 and 204: References 386. Ward E, King M, Llo
Page 205 and 206: References 417. Kirsch I, Deacon BJ
Page 207 and 208: References 451. Zigmond AS, Snaith
Page 209 and 210: References 486. Appleby L, Warner R
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References 520. Irwin M, Artin KH,
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References 557. Agnew F, Pulotu-End
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www.nzgg.co.nz www.moh.govt.nz
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Common Mental Disorders Depression - New Zealand Doctor

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