This clinical guideline was commissioned by NICE and developed by the National Collaborating Centre for Mental Health. It sets out clear, evidenceand consensus-based recommendations for healthcare staff on how to treat and manage depression in adults with a chronic physical health problem.

A fifth of people with a chronic physical health problem (such as cancer, diabetes, heart disease and stroke) have depression – a rate that is two to three times higher than in those who are in good physical health. A combination of depression and a chronic physical health problem can significantly worsen the negative outcomes for people with both conditions. The NICE guideline is an invaluable resource enabling healthcare professionals to address these problems and recognise, assess and offer effective treatments for depression in people with a chronic physical health problem.

The guideline reviews the evidence for the identification of depression in people with a chronic physical health problem and the associated service-level interventions (such as stepped care and collaborative care) and psychosocial, psychological and pharmacological interventions. It places special emphasis on advising health professionals about interactions between antidepressants and any prescribed medication for the physical health problem. As in the updated edition of the NICE guideline on depression, this guideline also covers subthreshold depressive symptoms. It has a useful introduction to depression in adults with a chronic physical health problem and a chapter on service user, carer and staff experience of care.

Contents

• GUIDELINE DEVELOPMENT GROUP MEMBERS
• ACKNOWLEDGEMENTS
• 1. PREFACE
  • 1.1. NATIONAL GUIDELINES
  • 1.2. THE NATIONAL GUIDELINE ON DEPRESSION IN ADULTS WITH A CHRONIC PHYSICAL HEALTH PROBLEM
• 2. DEPRESSION IN ADULTS WITH A CHRONIC PHYSICAL HEALTH PROBLEM
  • 2.1. INTRODUCTION
  • 2.2. DEPRESSION IN ADULTS WITH A CHRONIC PHYSICAL HEALTH PROBLEM
  • 2.3. THE RECIPROCAL RELATIONSHIP BETWEEN DEPRESSION AND CHRONIC PHYSICAL HEALTH PROBLEMS
  • 2.4. CONSEQUENCES OF DEPRESSION IN ADULTS WITH A CHRONIC PHYSICAL HEALTH PROBLEM
  • 2.5. THE ECONOMIC COST OF DEPRESSION IN ADULTS WITH A CHRONIC PHYSICAL HEALTH PROBLEM
• 3. METHODS USED TO DEVELOP THIS GUIDELINE
  • 3.1. OVERVIEW
  • 3.2. THE SCOPE
  • 3.3. THE GUIDELINE DEVELOPMENT GROUP
  • 3.4. CLINICAL QUESTIONS
  • 3.5. SYSTEMATIC CLINICAL LITERATURE REVIEW
  • 3.6. HEALTH ECONOMICS METHODS
  • 3.7. METHODS FOR REVIEWING EXPERIENCE OF CARE
  • 3.8. STAKEHOLDER CONTRIBUTIONS
  • 3.9. VALIDATION OF THE GUIDELINE
• 4. EXPERIENCE OF CARE
  • 4.1. INTRODUCTION
  • 4.2. PERSONAL ACCOUNTS
  • 4.3. QUALITATIVE ANALYSIS OF THE EXPERIENCE OF CARE FOR PEOPLE WITH A CHRONIC PHYSICAL HEALTH PROBLEM
  • 4.4. A QUALITATIVE ANALYSIS OF THE EXPERIENCE OF CARE FOR FAMILIES AND CARERS OF PEOPLE WITH A CHRONIC PHYSICAL HEALTH PROBLEM
  • 4.5. REVIEW OF THE QUALITATIVE LITERATURE
  • 4.6. SUMMARY OF THEMES
  • 4.7. FROM EVIDENCE TO RECOMMENDATIONS
  • 4.8. RECOMMENDATIONS
• 5. THE IDENTIFICATION OF DEPRESSION IN PEOPLE WITH A CHRONIC PHYSICAL HEALTH PROBLEM
  • 5.1. INTRODUCTION
  • 5.2. METHODS FOR DETECTING DEPRESSION
  • 5.3. CASE IDENTIFICATION IN BLACK AND MINORITY ETHNIC POPULATIONS
  • 5.4. OVERALL SUMMARY
  • 5.5. FROM EVIDENCE TO RECOMMENDATIONS
  • 5.6. RECOMMENDATIONS
• 6. SERVICE-LEVEL INTERVENTIONS FOR PEOPLE WITH DEPRESSION AND A CHRONIC PHYSICAL HEALTH PROBLEM
  • 6.1. INTRODUCTION
  • 6.2. CURRENT PRACTICE AND AIMS OF THE REVIEW
  • 6.3. STEPPED CARE
  • 6.4. SERVICE-LEVEL INTERVENTIONS
  • 6.5. ECONOMIC MODELLING: COST EFFECTIVENESS OF COLLABORATIVE CARE FOR PEOPLE WITH DEPRESSION AND A CHRONIC PHYSICAL HEALTH PROBLEM
  • 6.6. FROM EVIDENCE TO RECOMMENDATIONS
  • 6.7. RECOMMENDATIONS
  • 6.8. RESEARCH RECOMMENDATIONS
• 7. PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS FOR PEOPLE WITH DEPRESSION AND A CHRONIC PHYSICAL HEALTH PROBLEM
  • 7.1. INTRODUCTION
  • 7.2. REVIEW OF CLINICAL EVIDENCE FOR PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS
  • 7.3. HEALTH ECONOMIC EVIDENCE FOR PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS
  • 7.4. FROM EVIDENCE TO RECOMMENDATIONS
  • 7.5. RECOMMENDATIONS
  • 7.6. RESEARCH RECOMMENDATIONS
• 8. PHARMACOLOGICAL INTERVENTIONS IN THE TREATMENT AND MANAGEMENT OF DEPRESSION IN ADULTS WITH A CHRONIC PHYSICAL HEALTH PROBLEM
  • 8.1. INTRODUCTION
  • 8.2. EFFICACY OF PHARMACOLOGICAL INTERVENTIONS
  • 8.3. ADVERSE EFFECTS OF PHARMACOLOGICAL INTERVENTIONS
  • 8.4. INTERACTIONS BETWEEN MEDICATIONS FOR TREATING PHYSICAL HEALTH PROBLEMS AND ANTIDEPRESSANTS
  • 8.5. ANTIDEPRESSANT DISCONTINUATION SYMPTOMS
  • 8.6. HEALTH ECONOMIC EVIDENCE
  • 8.7. OVERALL SUMMARY ON EFFICACY, SAFETY, ADVERSE EFFECTS AND INTERACTIONS, AND ECONOMIC EVIDENCE
  • 8.8. FROM EVIDENCE TO RECOMMENDATIONS
  • 8.9. RECOMMENDATIONS
  • 8.10. RESEARCH RECOMMENDATIONS
• 9. SUMMARY OF RECOMMENDATIONS
  • 9.1. CARE OF ALL PEOPLE WITH DEPRESSION
  • 9.2. STEPPED CARE
  • 9.3. STEP 1: RECOGNITION, ASSESSMENT AND INITIAL MANAGEMENT IN PRIMARY CARE AND GENERAL HOSPITAL SETTINGS
  • 9.4. STEP 2: RECOGNISED DEPRESSION IN PRIMARY CARE AND GENERAL HOSPITAL SETTINGS – PERSISTENT SUBTHRESHOLD DEPRESSIVE SYMPTOMS OR MILD TO MODERATE DEPRESSION
  • 9.5. STEP 3: RECOGNISED DEPRESSION IN PRIMARY CARE AND GENERAL HOSPITAL SETTINGS – PERSISTENT SUBTHRESHOLD DEPRESSIVE SYMPTOMS OR MILD TO MODERATE DEPRESSION WITH INADEQUATE RESPONSE TO INITIAL INTERVENTIONS, AND MODERATE AND SEVERE DEPRESSION
  • 9.6. STEP 4: COMPLEX AND SEVERE DEPRESSION
  • 9.7. RESEARCH RECOMMENDATIONS
• APPENDICES
  • Appendix 1. Scope for the development of the clinical guideline
  • Appendix 2. Declarations of interest by Guideline Development Group members
  • Appendix 3. Special advisers to the Guideline Development Group
  • Appendix 4. Stakeholders and experts who submitted comments in response to the consultation draft of the guideline
  • Appendix 5. Stakeholders and experts who submitted comments in response to the pre-publication check
  • Appendix 6. Researchers contacted to request information about unpublished or soon-to-be published studies
  • Appendix 7. Clinical questions
  • Appendix 8. Clinical review protocol template
  • Appendix 9. Search strategies for the identification of clinical studies
  • Appendix 10. Clinical study data extraction form
  • Appendix 11. Quality checklists for clinical studies and reviews
  • Appendix 12. The classification of depression and depression rating scales/questionnaires
  • Appendix 13. Search strategies for the identification of health economic evidence
  • Appendix 14. Quality checklist for economic studies
  • Appendix 15. Data extraction form for economic studies
  • Appendix 16. Table of drug interactions
  • Appendix 17. Evidence tables for economic studies
  • Appendix 18. Clinical study characteristics tables
  • Appendix 19. Clinical evidence forest plots
  • Appendix 20. Case identification included and excluded studies
  • Appendix 21. GRADE evidence profiles
• REFERENCES
• ABBREVIATIONS

The views presented in this book do not necessarily reflect those of the British Psychological Society, and the publishers are not responsible for any error of omission or fact. The British Psychological Society is a registered charity (no. 229642).