CLINICAL GUIDELINE FOR THE DIAGNOSIS AND …...0 clinical guideline for the diagnosis and management...
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0 CLINICAL GUIDELINE FOR THE DIAGNOSIS AND MANAGEMENT OF WORK-RELATED MENTAL HEALTH CONDITIONS IN GENERAL PRACTICE Evidence Review Technical Report [Draft for public consultation] 12 JAN 18
Transcript of CLINICAL GUIDELINE FOR THE DIAGNOSIS AND …...0 clinical guideline for the diagnosis and management...
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CLINICALGUIDELINEFORTHEDIAGNOSISANDMANAGEMENTOFWORK-RELATEDMENTALHEALTHCONDITIONSINGENERALPRACTICEEvidenceReviewTechnicalReport[Draftforpublicconsultation]
12JAN18
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Tableofcontents
1 Introduction......................................................................................................................1
1.1 PurposeoftheGuideline...........................................................................................1
1.2 DevelopmentoftheGuideline...................................................................................1
1.3 KeyClinicalQuestions................................................................................................1
2 Methods............................................................................................................................3
2.1 Literaturesearch........................................................................................................3
2.1.1 Inclusioncriteria.................................................................................................3
2.1.2 Exclusioncriteria................................................................................................3
2.1.3 LiteratureScreeningandIdentifyingEligibleStudies.........................................4
2.1.4 SupplementationwithExistingClinicalPracticeGuidelinesandSystematicReviews4
2.2 Appraisingandsummarisingtheevidence................................................................4
2.3 DataAnalysisandSynthesis.......................................................................................5
2.4 Errorin“Work”SearchStrategyinEmbase,Medline,PsycINFOandAMED.............5
2.5 GradingtheEvidenceandFormulationofRecommendations................................10
3 Keyclinicalquestion1:Inworkerspresentingwithsymptomsofmentalhealthconditions,whattoolscanassistaGPinmakinganaccurate(sensitiveandspecific)diagnosisofandseverityofmentalhealthdisorders?...................................................11
3.1 EvidenceReviewRoundOne....................................................................................11
3.1.1 PICO..................................................................................................................11
3.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED................................11
3.1.3 SearchStrategy:CINAHL...................................................................................12
3.1.4 Searchperiod...................................................................................................14
3.1.5 PRISMAround1................................................................................................14
3.2 RecommendationsarisingfromGuidelineDevelopmentGroupmeeting...............15
3.3 Evidencereviewroundtwo......................................................................................15
3.3.1 PICO..................................................................................................................15
3.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED................................15
3.3.3 SearchStrategy:CINAHL...................................................................................16
3.3.4 Searchperiod...................................................................................................17
3.3.5 PRISMARound2...............................................................................................17
3.4 ExistingGuidelinesandSystematicReviewsforKeyclinicalquestion1..................19
3.4.1 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting.19
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3.4.2 PICO..................................................................................................................19
3.4.3 Guidelines.........................................................................................................203.4.3.1 Searchperiod............................................................................................................20
3.4.3.2 PRISMA-Guidelines.................................................................................................20
Systematicreviews...........................................................................................22
3.4.4 223.4.4.1 Searchperiod............................................................................................................22
3.4.4.2 Outcome...................................................................................................................22
3.5 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion1.....22
3.6 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:Keyclinicalquestion1.....................................................................................................23
4 Keyclinicalquestion2:Inpatientswithadiagnosedmentalhealthcondition,whatmethodsareeffectiveatindicatingtheprobabilitythatthediagnosedmentalhealthconditionhasarisenasaresultofwork?........................................................................31
4.1 Evidencereviewroundone......................................................................................31
4.1.1 PICO..................................................................................................................31
4.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED................................31
4.1.3 SearchStrategy:CINAHL...................................................................................32
4.1.4 Searchperiod...................................................................................................33
4.1.5 PRISMAroundone...........................................................................................34
4.2 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting.........34
4.3 Evidencereviewroundtwo......................................................................................34
4.3.1 PICO..................................................................................................................34
4.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED................................35
4.3.3 SearchStrategy:CINAHL...................................................................................36
4.3.4 Searchperiod...................................................................................................37
4.3.5 PRISMAround2................................................................................................37
4.4 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion2.....39
4.5 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:Keyclinicalquestion2:....................................................................................................40
5 Keyclinicalquestion3:Inworkers,whatfactorsassistintheearlydetectionofacomorbidwork-relatedmentalhealthcondition?..........................................................46
5.1 Evidencereviewroundone......................................................................................46
5.1.1 PICO..................................................................................................................46
5.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED................................46
5.1.3 SearchStrategy:CINAHL...................................................................................47
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5.1.4 Searchperiod...................................................................................................48
5.1.5 PRISMAround1................................................................................................48
5.2 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting.........49
5.3 Evidencereviewroundtwo......................................................................................49
5.3.1 PICO..................................................................................................................49
5.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED................................50
5.3.3 SearchStrategy:CINAHL...................................................................................50
5.3.4 Searchperiod...................................................................................................51
5.3.5 PRISMAroundtwo...........................................................................................51
5.4 ExistingGuidelinesandSystematicReviewsforKeyclinicalquestion3..................53
5.4.1 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting.53
5.4.2 PICO..................................................................................................................53
5.4.3 Guidelines.........................................................................................................545.4.3.1 Searchperiod............................................................................................................54
5.4.3.2 PRISMA-Guidelines.................................................................................................55
5.4.4 Systematicreviews...........................................................................................565.4.4.1 Searchperiod............................................................................................................56
5.4.4.2 PRISMA-Systematicreviews...................................................................................56
5.5 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion3.....57
5.6 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:Keyclinicalquestion3.....................................................................................................59
6 Keyclinicalquestion4:Inpatientswithwork-relatedstress,whatGPstrategiesresultinthehighestlevelsofpersonalrecoveryand/orreturntowork?....................................62
6.1 Evidencereviewroundone......................................................................................62
6.1.1 PICO..................................................................................................................62
6.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED................................62
6.1.3 SearchStrategy:CINAHL...................................................................................63
6.1.4 Searchperiod...................................................................................................64
6.1.5 PRISMAroundone...........................................................................................64
6.2 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting.........65
6.3 Evidencereviewroundtwo......................................................................................65
6.3.1 PICO..................................................................................................................65
6.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED................................66
6.3.3 SearchStrategy:CINAHL...................................................................................66
6.3.4 Searchperiod...................................................................................................67
6.3.5 PRISMAroundtwo...........................................................................................68
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6.4 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion4.....69
6.5 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:Keyclinicalquestion4.....................................................................................................71
7 Keyclinicalquestion5:Inpatientswithadiagnosisofawork-relatedmentalhealthcondition,whatfeatures(factors)leadtodelayedprogressinthepatient’scondition?83
7.1 Evidencereviewroundone......................................................................................83
7.1.1 PICO..................................................................................................................83
7.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED................................83
7.1.3 SearchStrategy:CINAHL...................................................................................84
7.1.4 Searchperiod...................................................................................................85
7.1.5 PRISMAroundone...........................................................................................85
7.2 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting.........85
7.3 Evidencereviewroundtwo......................................................................................86
7.3.1 PICO..................................................................................................................86
7.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED................................86
7.3.3 SearchStrategy:CINAHL...................................................................................87
7.3.4 Searchperiod...................................................................................................88
7.3.5 PRISMAroundtwo...........................................................................................88
7.4 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion5.....88
7.5 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:Keyclinicalquestion5.....................................................................................................89
8 Keyclinicalquestion6:Inpatientswithwork-relatedmentalhealthconditionswhoarenotimproving,whatstrategiesshouldageneralpractitionerundertaketoimprovethepatient’scondition?(e.g.identifyrecurrent/continuingstressors,newsymptoms/signs,newcomorbiditiessuchasdrugandalcoholuse)..........................................................93
8.1 Evidencereviewroundone......................................................................................93
8.1.1 PICO..................................................................................................................93
8.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED................................93
8.1.3 SearchStrategy:CINAHL...................................................................................94
8.1.4 Searchperiod...................................................................................................95
8.1.5 PRISMAround1................................................................................................95
8.2 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting.........95
8.3 Evidencereviewroundtwo......................................................................................96
8.3.1 PICO..................................................................................................................96
8.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED................................96
8.3.3 SearchStrategy:CINAHL...................................................................................97
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8.3.4 Searchperiod...................................................................................................97
8.3.5 PRISMAroundtwo...........................................................................................98
8.4 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion6.....98
8.5 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:Keyclinicalquestion6...................................................................................................101
9 Keyclinicalquestion7:ForGPswhoaremanagingpatientswithcompensationclaims,whatisappropriatecommunicationwiththepatient’sworkplace,inordertoappropriatelyinvestigateandmanageawork-relatedmentalhealthcondition?........107
9.1 Evidencereviewroundone....................................................................................107
9.1.1 PICO................................................................................................................107
9.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED..............................107
9.1.3 SearchStrategy:CINAHL.................................................................................108
9.1.4 Searchperiod.................................................................................................109
9.1.5 PRISMAroundone.........................................................................................109
9.2 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting.......109
9.3 Evidencereviewroundtwo....................................................................................110
9.3.1 PICO................................................................................................................110
9.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED..............................110
9.3.3 SearchStrategy:CINAHL.................................................................................110
9.3.4 Searchperiod.................................................................................................110
9.3.5 PRISMAroundtwo.........................................................................................110
9.4 ExistingGuidelinesandSystematicReviewsforKeyclinicalquestion7................112
9.4.1 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting112
9.4.2 PICO................................................................................................................112
9.4.3 Guidelines.......................................................................................................1139.4.3.1 SearchStrategy.......................................................................................................113
9.4.3.2 Searchperiod..........................................................................................................113
9.4.3.3 PRISMA-Guidelines...............................................................................................114
9.4.4 Systematicreviews.........................................................................................1149.4.4.1 Searchperiod..........................................................................................................115
9.4.4.2 PRISMA-Systematicreviews.................................................................................116
9.5 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion7...116
9.6 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:Keyclinicalquestion7...................................................................................................118
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10 Keyclinicalquestion8:Whenconveyingadiagnosisofawork-relatedmentalhealthconditiontoapatient,whatfactorsshouldGPsconsider,toensurethattheirdiagnosisisunderstoodandacknowledgedbythepatient?........................................................121
10.1 Evidencereviewroundone....................................................................................121
10.1.1 PICO................................................................................................................121
10.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED..............................121
10.1.3 SearchStrategy:CINAHL.................................................................................122
10.1.4 Searchperiod.................................................................................................123
10.1.5 PRISMAroundone.........................................................................................123
10.2 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting.......123
10.3 Evidencereviewroundtwo....................................................................................124
10.3.1 PICO................................................................................................................124
10.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED..............................124
10.3.3 SearchStrategy:CINAHL.................................................................................124
10.3.4 Searchperiod.................................................................................................124
10.3.5 PRISMAroundtwo.........................................................................................124
10.4 ExistingGuidelinesandSystematicReviewsforKeyclinicalquestion8................124
10.4.1 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting124
10.4.2 PICO................................................................................................................124
10.4.3 Guidelines.......................................................................................................12510.4.3.1 SearchStrategy...................................................................................................125
10.4.3.2 Searchperiod......................................................................................................125
10.4.3.3 PRISMA–Guidelines..........................................................................................126
10.4.4 Systematicreviews.........................................................................................12710.4.4.1 Searchperiod......................................................................................................128
10.4.4.2 PRISMA-Systematicreviews.............................................................................128
10.5 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion8...129
10.6 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:Keyclinicalquestion8...................................................................................................129
11 Keyclinicalquestion9:Inpatientswithwork-relatedmentalhealthconditions,whatinterventionsareeffectiveatmanagingcomorbidsubstancemisuseandaddictivedisordersbyGPs?..........................................................................................................132
11.1 Evidencereviewroundone....................................................................................132
11.1.1 PICO................................................................................................................132
11.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED..............................132
11.1.3 SearchStrategy:CINAHL.................................................................................133
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11.1.4 Searchperiod.................................................................................................134
11.1.5 PRISMAroundone.........................................................................................134
11.2 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting.......135
11.3 Evidencereviewroundtwo....................................................................................135
11.3.1 PICO................................................................................................................135
11.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED..............................135
11.3.3 SearchStrategy:CINAHL.................................................................................135
11.3.4 Searchperiod.................................................................................................135
11.3.5 PRISMAroundtwo.........................................................................................135
11.4 ExistingGuidelinesandSystematicReviewsforKeyclinicalquestion9................137
11.4.1 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting137
11.4.2 PICO................................................................................................................137
11.4.3 Guidelines.......................................................................................................13811.4.3.1 Searchperiod......................................................................................................138
11.4.3.2 PRISMA–Guidelines..........................................................................................138
11.4.4 Systematicreviews.........................................................................................14011.4.4.1 Searchperiod......................................................................................................140
11.4.4.2 PRISMA-Systematicreviews.............................................................................141
11.5 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion9...142
11.6 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:Keyclinicalquestion9...................................................................................................143
12 Keyclinicalquestion10:Inworkerswithamentalhealthcondition,whatinformationshouldaGPconsidertodeterminewhetherapersoniscapableandhascapacityto(returnto)work?...........................................................................................................146
12.1 Evidencereviewroundone....................................................................................146
12.1.1 PICO................................................................................................................146
12.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED..............................146
12.1.3 SearchStrategy:CINAHL.................................................................................147
12.1.4 Searchperiod.................................................................................................148
12.1.5 PRISMAroundone.........................................................................................148
12.2 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting.......149
12.3 Evidencereviewroundtwo....................................................................................149
12.3.1 PICO................................................................................................................149
12.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED..............................150
12.3.3 SearchStrategy:CINAHL.................................................................................151
12.3.4 Searchperiod.................................................................................................152
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12.3.5 PRISMAroundtwo.........................................................................................152
12.4 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion10.153
12.5 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:Keyclinicalquestion10.................................................................................................154
13 Appendices....................................................................................................................158
13.1 Appendix1QualityAssessmentofDiagnosticAccuracyStudies(QUADAS)Checklist158
13.2 Appendix2PatientHealthQuestionnaire-9(PHQ-9).............................................159
13.3 Appendix3Four-DimensionalSymptomQuestionnaire(4DSQ)...........................160
13.4 Appendix4PosttraumaticStressDisorderChecklist-Civilianversion(PCL-C))......163
13.5 Appendix5DepressionAnxietyStressScales........................................................164
13.6 Appendix6.GeneralizedAnxietyDisorder7-item(GAD-7)scale..........................165
13.7 Appendix7(AUDIT)Questionnaire........................................................................166
13.8 Appendix8.SeverityOfAlcoholDependenceQuestionnaire(SADQ)..................168
13.9 Appendix9.LeedsDependenceQuestionnaire(LDQ)...........................................170
13.10Appendix10NHMRCTechnicalReportRequirementsChecklist...........................171
14 References.....................................................................................................................173
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Listoftables
Table1.PICObasedinclusioncriteriaforeachkeyclinicalquestion ........................................ 7
Table2.GRADEqualityofevidenceratings ............................................................................. 10
Table3.Searchstrategyforexistingguidelinesforkeyclinicalquestion1 ............................ 20
Table4.Guidelineswithrecommendationsaddressingkeyclinicalquestion1 ..................... 21
Table5.Searchstrategyforexistingsystematicreviewsforkeyclinicalquestion1 .............. 22
Table6.Keyclinicalquestion1literaturesearchresultsandimplicationsarisingfromsearchstringsusedinrelationtowork ............................................................................................... 22
Table7.Commonlyusedwork-relatedMHCassessmenttools .............................................. 24
Table8.Qualityassessmentofstudiesofdiagnostictestaccuracy ........................................ 26
Table9.GRADEEvidenceProfileTable:Inworkerspresentingwithsymptomsofmentalhealthconditions,whattoolscanassistaGPinmakinganaccurate(sensitiveandspecific)diagnosisofandseverityofmentalhealthdisorders? ............................................................ 27
Table10.Listofguidelinesaddressingkeyclinicalquestion1 ................................................ 29
Table11.Keyclinicalquestion2literaturesearchresultsandimplicationsarisingfromsearchstringsusedinrelationtowork .................................................................................... 39
Table12.DownsandBlackChecklistqualityassessmentscoresforstudiesincludedinkeyclinicalquestion2 .................................................................................................................... 41
Table13.GRADEEvidenceProfileTable:Inpatientswithadiagnosedmentalhealthcondition,whatmethodsareeffectiveatindicatingtheprobabilitythatthediagnosedmentalhealthconditionhasarisenasaresultofwork? ......................................................... 42
Table14.InstrumentevaluationusingtheNHSR&DHTAcriteria .......................................... 44
Table15.Searchstrategyforexistingguidelinesforkeyclinicalquestion3 .......................... 54
Table16.Guidelineswithrecommendationsaddressingkeyclinicalquestion3 ................... 55
Table17.Searchstrategyforexistingsystematicreviewsforkeyclinicalquestion1 ............ 56
Table18.Keyclinicalquestion3literaturesearchresultsandimplicationsarisingfromsearchstringsusedinrelationtowork .................................................................................... 57
Table19.DownsandBlackChecklistqualityassessmentscoresforstudiesincludedinkeyclinicalquestion3 .................................................................................................................... 60
Table20.GRADEEvidenceProfileTable:Inworkers,whatfactorsassistintheearlydetectionofacomorbidwork-relatedmentalhealthcondition? ........................................... 61
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Table21.Keyclinicalquestion4literaturesearchresultsandimplicationsarisingfromsearchstringsusedinrelationtowork .................................................................................... 69
Table22.DownsandBlackChecklistqualityassessmentscoresforstudiesincludedinkeyclinicalquestion4 .................................................................................................................... 72
Table23.GRADEEvidenceProfileTable:Inpatientswithamentalhealthcondition,whatGPstrategiesresultinthehighestlevelsofpersonalrecoveryandreturntowork? .................. 73
Table24.Listofexistingsystematicreviewsaddressingkeyclinicalquestion4 .................... 79
Table25.Summaryevidencetableofsystematicreviewsthataddressedthescopeforkeyclinicalquestion4 .................................................................................................................... 81
Table26.Keyclinicalquestion5literaturesearchresultsandimplicationsarisingfromsearchstringsusedinrelationtowork .................................................................................... 88
Table27.DownsandBlackChecklistqualityassessmentscoresforstudiesincludedinkeyclinicalquestion5 .................................................................................................................... 90
Table28.AdaptedCASPqualitychecklistassessmentofqualitativestudiesincludedinkeyclinicalquestion5 .................................................................................................................... 90
Table29.Listofexistingreviewsaddressingkeyclinicalquestion5 ...................................... 90
Table30.GRADEEvidenceProfileTable:Inpatientswithadiagnosisofawork-relatedmentalhealthcondition,whatfactorsadverselyaffectprogressinpatient’scondition? ..... 91
Table31.Keyclinicalquestion6literaturesearchresultsandimplicationsarisingfromsearchstringsusedinrelationtowork .................................................................................... 98
Table32.DownsandBlackChecklistqualityassessmentscoresforstudiesincludedinkeyclinicalquestion6 .................................................................................................................. 102
Table33.Listofexistingreviewsaddressingkeyclinicalquestion6 .................................... 103
Table34.GRADEEvidenceProfileTable: Inpatientswithwork-relatedmentalhealthconditionswhoarenotimproving,whatstrategiesshouldageneralpractitionerundertaketoimprovethepatient’scondition? ...................................................................................... 104
Table35.Searchstrategyforexistingguidelinesforkeyclinicalquestion7 ........................ 113
Table36.Guidelineswithrecommendationsaddressingkeyclinicalkeyclinicalquestion7................................................................................................................................................ 114
Table37.Searchstrategyforexistingsystematicreviewsforkeyclinicalquestion7 .......... 114
Table38.Keyclinicalquestion7literaturesearchresultsandimplicationsarisingfromsearchstringsusedinrelationtowork .................................................................................. 116
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Table39.DownsandBlackChecklistqualityassessmentscoresforstudiesincludedinkeyclinicalquestion7 .................................................................................................................. 119
Table40.GRADEEvidenceProfileTable:Whatisappropriatecommunicationwiththepatient’sworkplaceinordertoappropriatelymanageawork-relatedmentalhealthcondition? .............................................................................................................................. 120
Table41.Searchstrategyforexistingguidelinesforkeyclinicalquestion8 ........................ 125
Table42.Guidelineswithrecommendationsaddressingkeyclinicalquestion8 ................. 126
Table43.Searchstrategyforexistingsystematicreviewsforkeyclinicalquestion8 .......... 127
Table44.Keyclinicalquestion8literaturesearchresultsandimplicationsarisingfromsearchstringsusedinrelationtowork .................................................................................. 129
Table45.Listofexistingpracticeguidelinesaddressingkeyclinicalquestion8 .................. 130
Table46.Searchstrategyforexistingguidelinesforkeyclinicalquestion9 ........................ 138
Table47.Guidelineswithrecommendationsaddressingkeyclinicalquestion9 ................. 139
Table48.Searchstrategyforexistingsystematicreviewsforkeyclinicalquestion9 .......... 140
Table49.Systematicreviewswithfindingsaddressingkeyclinicalquestion9 .................... 141
Table50.Keyclinicalquestion9literaturesearchresultsandimplicationsarisingfromsearchstringsusedinrelationtowork .................................................................................. 142
Table51.DownsandBlackChecklistqualityassessmentscoresforstudiesincludedinkeyclinicalquestion9 .................................................................................................................. 143
Table52.Listofexistingreviewsaddressingkeyclinicalquestion9 .................................... 143
Table53.Listofexistingpracticeguidelinesaddressingkeyclinicalquestion9 .................. 144
Table54.GRADEEvidenceProfileTable:Inpatientswithwork-relatedmentalhealthconditions,whatinterventionsareeffectiveatmanagingcomorbidsubstancemisuseandaddictivedisordersbyGPs? ................................................................................................... 145
Table55.Keyclinicalquestion10literaturesearchresultsandimplicationsarisingfromsearchstringsusedinrelationtowork .................................................................................. 153
Table56.DownsandBlackChecklistqualityassessmentscoresforstudiesincludedinkeyclinicalquestion10 ................................................................................................................ 155
Table57.GRADEEvidenceProfileTable:Inworkerswithamentalhealthcondition,whatinformationshouldaGPconsidertodeterminewhetherapersonhascapacitytoreturntowork? ..................................................................................................................................... 156
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Listoffigures
Figure1.GRADEcategorisationofstrengthofrecommendation ........................................... 10
Figure2.RoundonePRISMAchartforkeyclinicalquestion1 ................................................ 14
Figure3.RoundtwoPRISMAchartofkeyclinicalquestion1updates ................................... 18
Figure4.CombinedroundoneandroundtwoPRISMAchartforkeyclinicalquestion1 ...... 19
Figure5.PRISMAflowchartofguidelinesforkeyclinicalquestion1 ..................................... 21
Figure6.RoundonePRISMAchartforkeyclinicalquestion2 ................................................ 34
Figure7.RoundtwoPRISMAchartofkeyclinicalquestion2updates ................................... 38
Figure8.CombinedroundoneandroundtwoPRISMAchartforkeyclinicalquestion2 ...... 39
Figure9.RoundonePRISMAchartforkeyclinicalquestions3 .............................................. 49
Figure10.RoundtwoPRISMAchartofkeyclinicalquestion3updates ................................. 52
Figure11.CombinedroundoneandroundtwoPRISMAchartforkeyclinicalquestion3 .... 53
Figure12.PRISMAchartofguidelinesforkeyclinicalquestion3 ........................................... 55
Figure13.PRISMAchartofsystematicreviewsforkeyclinicalquestion3 ............................ 57
Figure14.Searchoutcomeforkeyclinicalquestion3followingevidencereviewrecommendations .................................................................................................................... 59
Figure15.RoundonePRISMAchartforkeyclinicalquestion4 .............................................. 65
Figure16.RoundtwoPRISMAchartofkeyclinicalquestion4updates ................................. 68
Figure17.CombinedroundoneandroundtwoPRISMAchartforkeyclinicalquestion4 .... 69
Figure18.Searchoutcomeforkeyclinicalquestion4followingevidencereviewrecommendations .................................................................................................................... 71
Figure19.PRISMAchartofadditionalscreeningandreviewformeta-analysesandreviewsforquestion4 ........................................................................................................................ 80
Figure20.RoundonePRISMAchartforkeyclinicalquestion5 .............................................. 85
Figure21.CombinedroundoneandroundtwoPRISMAchartforkeyclinicalquestion5 .... 88
Figure22.RoundonePRISMAchartforkeyclinicalquestion6 .............................................. 95
Figure23.CombinedroundoneandroundtwoPRISMAchartforkeyclinicalquestion6 .... 98
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Figure24.Flowchartshowingresultsandoptionwhenmeta-analysisorsystematicreviewslimitsareappliedtothesearch ............................................................................................. 100
Figure25.PRISMAchartofadditionalscreeningandreviewformeta-analysesandreviewsforquestion6 ......................................................................................................................... 101
Figure26. RoundonePRISMAchartforkeyclinicalquestion7 ........................................... 109
Figure27.RoundtwoPRISMAchartofkeyclinicalquestion7updates ............................... 111
Figure28.CombinedroundoneandroundtwoPRISMAchartforkeyclinicalquestion7 .. 112
Figure29.PRISMAchartofguidelinesforkeyclinicalquestion7 ......................................... 114
Figure30.PRISMAchartofsystematicreviewsforkeyclinicalquestion7 .......................... 116
Figure31.Searchoutcomeforkeyclinicalquestion7followingevidencereviewrecommendations .................................................................................................................. 118
Figure32.RoundonePRISMAchartforkeyclinicalquestion8 ............................................ 123
Figure33.PRISMAchartofguidelinesforkeyclinicalquestion8 ......................................... 126
Figure34.PRISMAchartofsystematicreviewsforkeyclinicalquestion8 .......................... 128
Figure35.RoundonePRISMAchartforkeyclinicalquestion9 ............................................ 134
Figure36.RoundtwoPRISMAchartofkeyclinicalquestion9updates ............................... 136
Figure37.CombinedroundoneandroundtwoPRISMAforkeyclinicalquestion9 ........... 137
Figure38.PRISMAchartofguidelinesforkeyclinicalquestion9 ......................................... 139
Figure39.PRISMAflowchartofsystematicreviewsforkeyclinicalquestion9 .................. 141
Figure40.RoundonePRISMAchartforkeyclinicalquestion10 .......................................... 149
Figure41.CombinedroundoneandroundtwoPRISMAchartforkeyclinicalquestion10 153
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Listofabbreviations
4DSQ FourDimensionalSymptomsQuestionnaire
ADIS Anxietydisordersinterviewschedule
AGREE AppraisalofGuidelinesforResearchandEvaluation
AMSTAR AMeasurementTooltoAssessSystematicReviews
AUDIT-C AlcoholUseDisordersIdentificationTest-Consumption
AUDIT-PC AlcoholUseDisordersIdentificationTest-PrimaryCare
BAI BeckAnxietyInventory
BDI BeckDepressionInventory
BDI-IA BeckDepressionInventory-versionIA
BDI-II BeckDepressionInventory-versionII
BRFSS BehaviouralRiskFactorSurveillanceSystem
BSI BriefSymptomInventory
BSI-18 BasicSymptomInventory-18Item
CAPS Clinician'sAdministered/AssessmentofPTSDScale
CES-D CenterforEpidemiologicStudiesDepressionScale
CHIME Connectedness;Hopeandoptimismaboutthefuture;Identity;Meaninginlife;andEmpowerment
CIDI CompositeInternationalDiagnosticInterview
CNAHL CurrentNursingandAlliedHealthLiterature
DASS DepressionAnxietyStressScales
DSM-IV DiagnosticandStatisticalManualofMentalDisorders,4thEdition
GAD-2 GeneralizedAnxietyDisorder-2Itemscale
GDG GuidelineDevelopmentGroup
GHQ GeneralHealthQuestionnaire
GHQ-12 GeneralHealthQuestionnaire-12Item
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GHQ-28 GeneralHealthQuestionnaire-28Item
GIN GuidelinesInternationalNetwork
GP GeneralPractitioner
GRADE GradingofRecommendations,Assessment,DevelopmentandEvaluation
HADS HospitalAnxietyandDepressionScale
HAM-A HamiltonAnxietyRatingScale
HAM-D HamiltonDepressionRatingScale
ICSI InstituteforClinicalSystemsImprovement
IES ImpactofEventsScale
IES-E ImpactofEventsScale-extendedversion
IES-R ImpactofEventScale-Revised
MADRS Montgomery-ÅsbergDepressionRatingScale
MHC MentalHealthConditionsMINI MINI-InternationalNeuropsychiatricInterview
NGC NationalGuidelineClearinghouse
NHMRC NationalHealthandMedicalResearchCouncil
NICE NationalInstituteforHealthandCareExcellence
PCL-C PosttraumaticStressDisorderChecklist-CivilianVersion
PHQ PatientHealthQuestionnaire
PHQ-2 PatientHealthQuestionnaire-2Item
PHQ-4 PatientHealthQuestionnaire-4Item
PHQ-9 PatientHealthQuestionnaire-9Item
PICO Population,Intervention,Comparator,Outcome
PRISMA PreferredReportingItemsforSystematicReviewsandMeta-Analyses
PSS PTSDsymptomscale
PTSD Post-traumaticStressDisorder
xvi
QUADAS QualityAssessmentofDiagnosticAccuracyStudies
RACGP RoyalAustralianCollegeofGeneralPractitioners
RANZCP RoyalAustralianandNewZealandCollegeofPsychiatrists
RTW Returntowork
SASQ AlcoholScreeningQuestionnaire
SCID StructuredClinicalInterviewforDiagnosis
SCL-90R SymptomChecklist90-Revised
SCL-90 SymptomChecklist90
SF-8MCS ShortForm-8MentalComponentScale
SF-36 ShortForm-36
SIGN ScottishIntercollegiateGuidelinesNetwork
TABS TraumaAttachmentandBeliefScale
VaDoD DepartmentofVeteransAffairs
WHO WorldHealthOrganization
1
1 Introduction
1.1 PurposeoftheGuideline
Following on previous work which established that Australian general practitioners (GPs)experienceddifficultieswithmanagingwork-relatedmentalhealthconditions,thepurposeof thisclinicalguideline is toassistGPs in thediagnosisandmanagementofwork-relatedadjustment disorders, depression, post-traumatic stress disorders, stress and anxiety.ClinicalPracticeQuestionshavebeenoutlinedinSection3below.
1.2 DevelopmentoftheGuideline
Theevidencefortherecommendationsarisingfromthisworkwerebasedonasystematicreviewof the literature.Where applicable, and as per theGuidelineDevelopmentGrouprecommendations,thesystematicreviewwassupplementedwithareviewofexistinghigh-qualityguidelinesandsystematicreviews.
Theprocessfordevelopingtheguidelineinvolved:
1. Developmentofprioritykeyclinicalquestions2. Areviewofevidenceusingasystematic literaturereviewwhichwassupplemented
with existing relevant high-quality guidelines and systematic reviews whereapplicable
3. FormulationofevidenceorconsensusbasedrecommendationsbythemembersoftheGuidelineDevelopmentGroup
4. Releaseofthedraftguidelineforpublicconsultation5. Independentexpertpeer-reviewpriortothefinalrelease
1.3 KeyClinicalQuestions
Thelistofquestionstobeaddressedintheguidelinewasdevelopedthroughatwo-phaseprocess. Phase one involved a review of the National Institute for Health and CareExcellence (NICE) 1 and the World Health Organization 2 frameworks for generatingquestionsforclinicalguidelinedevelopment.Phasetwowasthelatterprocessaugmentedwith relevant stakeholder (GPs, compensation scheme workers and psychiatrists) views,which involved empirical research using semi-structured interviews with case vignettes.MembersoftheGuidelineDevelopmentGroupreviewedthequestionsandagreedonthefollowing(NB.SomeareaswererevisedbytheGroupatmeetingtwo):
1. Inworkers presentingwith symptomsofmental health conditions,what tools canassistaGPinmakinganaccurate(sensitiveandspecific)diagnosisofandseverityofmentalhealthdisorders?
2. Inpatientswithadiagnosedmentalhealthcondition,whatmethodsareeffectiveatindicatingtheprobabilitythatthediagnosedmentalhealthconditionhasarisenasaresultofwork?
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3. In workers, what factors assist in the early detection of a comorbid work-relatedmentalhealthcondition?
4. Inpatientswithamentalhealthcondition,whatGPstrategiesresult inthehighestlevelsofpersonalrecoveryand/orreturntowork?
5. Inpatientswithadiagnosisofawork-relatedmentalhealthcondition,whatfactorsadverselyaffectprogressinthepatient’scondition?
6. Inpatientswithwork-relatedmentalhealthconditionswhoarenotimproving,whatstrategies should a general practitioner undertake to improve the patient’scondition?
7. What is appropriate communication with the patient’s workplace in order toappropriatelymanageawork-relatedmentalhealthcondition?
8. Whenconveyingadiagnosisofawork-relatedmentalhealthconditiontoapatient,what factorsshouldGPsconsider, toensurethattheirdiagnosis isunderstoodandacknowledgedbythepatient?
9. In patients with work-related mental health conditions, what interventions areeffectiveatmanagingcomorbidsubstancemisuseandaddictivedisordersbyGPs?
10. Inworkerswithamentalhealthcondition,whatinformationshouldaGPconsidertodeterminewhetherapersonhascapacitytoreturntowork?
3
2 Methods
Asystematicliteraturereviewwasperformedbytwoindependentreviewerstodeveloptheevidencebasefortherecommendations.Thedetailsofthereviewmethodsaredescribedinthe next subsections. Other details that are specific for each question, including changesrecommendedbytheGuidelineDevelopmentGrouparepresentedinsubsequentquestionsections.Onepersonconductedtheliteraturesearchtheelectronicdatabasesandanotherperformed another search specifically focussed on existing practice guidelines andsystematic reviews. Two reviewers then independently conducted the review; fromscreeningtoselectionofstudiesforinclusiontoqualityassessmentanddataextraction.
2.1 Literaturesearch 2.1.1 Inclusioncriteria
Each question in the review addressed a different aspect of clinical practice, hencevariabilityinoutcomes.Asaresult,someinclusioncriteriawerequestionspecific(seeTable1).Thecommonbroaderinclusioncriteriawere:
• Population–patientswithadjustmentdisorders, depression,post-traumatic stressdisorders,stressoranxiety
• Typesofstudies–studiesofalltypesofdesignpublishedintheEnglishlanguage• Outcomes – Diagnosis, risk factors and management of patients with adjustment
disorders, depression, post-traumatic stress disorders, stress or anxiety in theworkingpopulation
2.1.2 Exclusioncriteria
Exclusioncriteriawere:
• Anymental health condition, e.g. schizoaffective disorders, other than adjustmentdisorders,depression,post-traumaticstressdisorders,stressoranxiety
• Substanceuseoraddictivedisordersoccurring in isolationofadjustmentdisorders,depression,post-traumaticstressdisorders,stressoranxiety
• Studies that had limited scope of application, i.e. conducted in highly specificcontexts and deemed to have low generalisability, i.e. studies in distinctivelyhomogenousandhighlyselectivepopulationgroups
• Non-English languagepublicationsor full text articles that couldnotbe locatedorsourced
The project evidence reviewer undertook the literature search. A preliminary first roundsearch for studies was performed in Medline, EMBASE, PsycINFO and Allied andComplementaryMedicine databases (AMED) in Ovid® and CINHAL. The searches covered
4
the period from inception of the database to the 31st of January 2017.Members of theGuideline Development Group then reviewed and discussed the preliminary results andevidence,andsuggestedchangestosomeofthekeyclinicalquestions,thesearchstrategy,inclusioncriteriaorsupplementationwithexistingclinicalpracticeguidelines.Followingthis,second round updated searches were performed on the 1st ofMay 2017 for the periodbetweenthe1stofFebruary2017andthe30thofApril2017.However,forsomekeyclinicalquestions, the search started from database inception. Final targeted updates wereperformedonthe6thofNovember2017forkeyclinicalquestionfour.
2.1.3 LiteratureScreeningandIdentifyingEligibleStudies
Titles and abstracts of the search resultswere collated in EndNote X8™ and exported toCovidence (https://www.covidence.org/), an online platform for managing systematicreviews for screening. The evidence reviewer and a second reviewer independentlyscreened the titles and abstracts (or full text articles where there were no abstracts orrelevance could not be determined from the title and abstract only) for relevance. Theproject manager was on standby to mediate conflicts. The two independent reviewersproceeded to full text article review for further eliminationof irrelevant publications andassessmentofstudiesfor inclusionorexclusionwithreasons.Screeningforguidelinesandsystematicreviews,whereapplicable,followedasimilarscreeningandreviewprocess.
2.1.4 SupplementationwithExistingClinicalPracticeGuidelinesandSystematicReviews
At meeting 3, the Guideline Development Group recommended supplementing theevidencereviewforkeyclinicalquestions1,3,7,8and9withexistinghighqualityclinicalpracticeguidelinesandsystematicreviews.Inbrief,atargetedsearchofrelevantguidelineswas performed in known clinical practice guidelines databases and host portals (NICE,Scottish IntercollegiateGuidelinesNetwork (SIGN),NationalHealth andMedical ResearchCouncil (NHMRC), National Guidelines Clearinghouse (NGC), Guidelines InternationalNetwork(GIN))aswellasaGooglesearch.Theprojectmanagerperformedthesearchforexisting practice guidelines and systematic reviews and the search dates for these areindicatedineachsectionwherethisapplied.Detailsofthesearchstrategyaredescribedinasectionundereachkeyclinicalquestionchapterwherethiswasapplicable.
2.2 Appraisingandsummarisingtheevidence
Included studies were assessed for methodological quality using the Downs and Blackchecklist 3 for interventional and prognostic studies.While the checklist has amaximumtotalscoreof31weusedthemodifiedversionwithquestion27scoreas0or1insteadoftheusual0to5.Themaximumpossiblescoreforthemodifiedversionis28.Therearenoestablishedquality thresholds for theDownsandBlackchecklistandour review teamdidnotusethescoresasaninclusionorexclusionfactor.BecausetheDownandBlackchecklistismoresuitedforquantitativestudies,adecisionwasmadetoreassessqualitativestudies
5
usinganadaptedCriticalAppraisalSkillsProgram(CASP)qualitativechecklist4.TheQualityAssessment of Diagnostic Accuracy Studies (QUADAS) checklist 5 was used for studies ofdiagnostictestaccuracy,andAMeasurementTooltoAssessSystematicReviews(AMSTAR)6for systematic reviews; maximum possible score = 11. The reviewers then extractedquantitative and/or qualitative data from relevant included studies and the evidencereviewersynthesisedthedata.Wheretheevidencewassupplementedwithexistingclinicalpractice guidelines, theAppraisal ofGuidelines forResearch andEvaluation (AGREE) toolwasusedforqualityassessment.Thetworeviewerscoreswerecombinedintoascoreoutof 100% followingGAREEprocedures. For key clinical question2, selectionof assessmenttools forworkplace environmentor job characteristics assessment toolswas informedbythe criteria outlined in Bowling 7 and theNHS R&DHealth TechnologyAssessment (HTA)Programmereview8.
The available evidence for each key clinical question was recorded in the summary andevidencetables.Thesetableswerereviewedbythereviewteamforclarityandcorrections.Thesewere subsequently reviewed bymembers of the Guideline Development Group inthreestagesoverthreemeetings.Thethirdandfinalmeetingsreviewedtheevidence,thefirstmeetingreviewedtheinitialsearchfindings.
2.3 DataAnalysisandSynthesis
Qualityassessmentscores(DownsandBlackChecklist)fromthetworeviewswereaveragedfor each included study presented as separate domain scores. A combined mean andstandard deviation score for all included studieswas computed. Similarly, average scores(AMSTAR) for each included systematic review were computed. Consensus was used forQUADAS scoring,while the two reviewer’s scores for existing guidelineswere aggregatedintoasingleascorefollowingtherecommendedAGREEprocedure910.
The included studies were highly variable in their design, type of interventions andoutcomes,thereforeprecludingpooledresultsmeta-analysis.Instead,absoluteeffectsand95% confidence intervals (CI) of individual study outcomes were computed; meandifferencesforcontinuousoutcomesandpercentageratedifferenceforproportions.Wherestudies reported outcomes as odds ratios, these were directly reported in our data.Summaryresultswerethenreportedasrangesofthe95%CIforallstudies.Qualitativedataweresynthesisedusingmeta-aggregationanddescriptivenarratives.
2.4 Errorin“Work”SearchStrategyinEmbase,Medline,PsycINFOandAMED
Anerrorwasdiscovered in the search string for “work”whendataquality control checksweremadeaftertheguidelinedevelopmentgroupmeeting3.Theerroraffectedbothroundone and two search results from Embase, Medline, PsycINFO and AMED only and notCINAHL.TheimplicationoftheerrorwasthatsearchresultsinOvidwereconstrainedtotheconceptof“work”inthecompensablework(injury)setting.Inordertoevaluatetheimpact
6
ofthiserror,thesearchwasre-rumwiththecorrectedsearchstringfor“work”andresultsweretabulatedtohighlightthedifferencesinthesearchoutcomesbetweentheerroneoussearchandcorrectedsearch.
BecauseofthetimelapsesincetheroundoneandroundtwosearcheswereperformedaswellaslimitationsinthedatabasesearchperiodfiltersinOvid,adjustmentshadtobemadetosearchperiod limiters.Therefore, for thesearch re-run,estimatesof thesearch resultshighlighting the impact from the corrected “work” search string are based on the periodfromdatabaseinceptionuptotheendof2016forroundone.Henceanydatabaselistingsthat occurred in January 2017 are not included, resulting in an underestimation by onemonth. For round two, the estimates are from database inception to the 22nd of August2017(searchre-rundate)whereafullsearchwasrequired.Forupdatesonlyfromthe1stofFebruary2017tothe30thofApril,theestimatesarefromthebeginningof2017tothe22ndof August 2017, meaning there is an overestimation by approximately two and a halfmonths’worthofsearchhit.ThesecitationswerethenexportedtoEndNote8™toremoveduplicates. The remaining citations (titles and abstracts) were exported to Covidence forscreening. Finally, theevidence review teamundertook the following actions tomitigatethiserror:
i. Keyclinicalquestion3:Forkeyclinicalquestion3,thereviewconsideredanadditional615hitsinOVIDthatwouldhaveoccurredasaresultofthesearchstringerrorcorrectioninroundtwoinordertoinformthefinalguidelinerecommendationoftheGuidelineDevelopmentGroup.
ii. Keyclinicalquestion4:Forkeyclinicalquestion4,thereviewconsideredanadditional126hitsinOVIDthatwouldhaveoccurredasaresultofthesearchstringerrorcorrectioninroundtwoinordertoinformthefinalguidelinerecommendationoftheGuidelineDevelopmentGroup.Thereviewalsoconsideredallsystematicreviewsandmeta-analysesthatwouldhavebeenidentifiedhadthecorrectedsearchstringbeenincludedinround1.Atargetedsearchforsystematicreviewsandmeta-analyseswasconductedinEmbase,Medline,PsycINFOandAMEDfrominceptionto6Nov2017.
iii. Keyclinicalquestion6:Forkeyclinicalquestion6,thereviewconsideredallsystematicreviewsandmeta-analysesthatwouldhavebeenidentifiedhadthecorrectedsearchstringbeenincludedinround1.Atargetedsearchforsystematicreviewsandmeta-analyseswasconductedinEmbase,Medline,PsycINFOandAMEDfrominceptionto6Nov2017.
iv. Keyclinicalquestion7:Forkeyclinicalquestion7,thereviewconsideredanadditional110hitsinOVIDthatwouldhaveoccurredasaresultofthesearchstringerrorcorrectioninroundtwoinordertoinformthefinalguidelinerecommendationoftheGuidelineDevelopmentGroup.
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Table1.PICObasedinclusioncriteriaforeachkeyclinicalquestion
Question Population Intervention Comparator Outcomes Studytype1.Assessmenttools Peoplewithadjustment
disorders,depression,post-traumaticstressdisorders,stressoranxiety
Allassessmenttoolswithdiagnosticaccuracytesting
Establishedreferencestandardtools
Accuratediagnosisandassessmentofseverityofmentalhealthcondition
Diagnosticaccuracytesting
2.Assessmentpfprobabilityofwork-relatedness
Peoplewithadjustmentdisorders,depression,post-traumaticstressdisorders,stressoranxiety
Standardisedtoolsassessingpsychosocialcharacteristicsofthejobandworkplaceenvironment
Noneothervalidatedtools Methodsindicatingprobabilitythatamentalhealthconditionarosefromwork
Anywithtoolpsychometricproperties(reliabilityand/orvalidity)
3.Earlydetectioncomorbidwork-relatedmentalhealthcondition
Peoplewithadjustmentdisorders,depression,post-traumaticstressdisorders,stressoranxiety
Predictorsofonsetofadjustmentdisorders,depression,post-traumaticstressdisorders,stressoranxiety
Peoplewhodonotdevelopadjustmentdisorders,depression,post-traumaticstressdisorders,stressoranxiety
Earlydetection
Anyidentifyingprognosticorpredictivefactors
4.Strategiesresultinthehighestlevelsofpersonalrecoveryand/orreturntowork
Peoplewithadjustmentdisorders,depression,post-traumaticstressdisorders,stressoranxiety
Alltypesofstrategies/interventions
Anyalternativeorroutineinterventions
PersonalrecoveryReturntowork
Interventionalstudies
5.Adverseprogress Peoplewithadjustmentdisorders,depression,post-traumaticstressdisorders,stressoranxiety
Predictorsofrelativelyslowrecoveryand/orreturntoworkfollowingadiagnosisofadjustmentdisorders,depression,post-traumaticstressdisorders,stressoranxiety
Peoplewhorecoverand/orreturntoworkrelativelyearlyfollowingadiagnosisofadjustmentdisorders,depression,post-traumaticstressdisorders,stressoranxiety
PersonalrecoveryReturntowork
Anyidentifyingprognosticorpredictivefactors
6.Non-improvingpatients Peoplewithtreatmentresistantadjustmentdisorders,depression,post-traumaticstressdisorders,stressoranxiety
Alltypesofinterventions Anyalternativetreatment PatientrecoveryPatientsatisfaction
Interventionalstudies
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Question Population Intervention Comparator Outcomes Studytype7.Appropriatecommunicationwithworkplace
Healthprofessionals,employers Informationaboutcommunicationbetweenhealthprofessionalsandthepatientworkplace
Anyalternativesornone Appropriateinvestigationofawork-relatedmentalhealthconditionAvoidanceofissuewithemployerPatientsatisfactionPatientmayreturntoworkearly(ifmediationoccursearly)
Anydescribingcommunicationbetweenhealthprofessionalandpatientworkplace
8.Patientunderstandingofdiagnosis
HealthprofessionalsandPeoplewithtreatmentresistantadjustmentdisorders,depression,post-traumaticstressdisorders,stressoranxiety
Factorsforconsiderationtoensurepatientunderstandingandacknowledgmentofdiagnosis
Anyalternativesornone ClearcommunicationAccurateunderstandingofdiagnosisManagementofpatientexpectations
Anydescribingpatientunderstanding
9.Managingcomorbidsubstancemisuseandaddictivedisorders
Peoplewithtreatmentresistantadjustmentdisorders,depression,post-traumaticstressdisorders,stressoranxietyandcomorbidsubstanceuseand/oraddictivedisorders
Alltypesofinterventionsforeffectivemanagementofsubstanceuseand/oraddictivedisordersinpeoplewithtreatmentresistantadjustmentdisorders,depression,post-traumaticstressdisorders,stressoranxiety
Anyalternativeroutineornointervention
Evidence-basedeffectivemanagementofcomorbidities
Interventionalstudies
10.Capacitytoreturntowork
Peoplewithtreatmentresistantadjustmentdisorders,depression,post-traumaticstressdisorders,
Predictorsandinformationtoconsiderindeterminingcapacitytoreturntoworkfollowinga
Peoplewithfailedreturntoworkfollowingadiagnosisofadjustmentdisorders,
Alternative/suitableduties
Anystudiesdescribingprognosticfactors
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Question Population Intervention Comparator Outcomes Studytypestressoranxiety diagnosisofadjustmentdisorders,
depression,post-traumaticstressdisorders,stressoranxiety
depression,post-traumaticstressdisorders,stressoranxiety
Patientfactors(healthandwellbeing)Workplace/workenvironment(e.g.psychosocial)factorsReadinesstofacestigmawhenreturningtowork
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2.5 GradingtheEvidenceandFormulationofRecommendations
Evidencefromappraisaloftheliteratureforeachkeyclinicalquestionwassummarisedinto
evidencetables.Thereviewteamassignedqualityofratingstotheevidencefollowingthe
GradingofRecommendations,Assessment,DevelopmentandEvaluation(GRADE)process11
(Table 2). Ratings reflect the degree of confidence in the ensuing evidence from the
appraised literature and were upgraded or downgraded depending on factors around
methodologicalqualityofthestudiesandthemagnitudeofeffect11.
Table2.GRADEqualityofevidenceratings
Grade DefinitionHigh Weareveryconfidentthatthetrueeffectliesclosetothatoftheestimateof
theeffectModerate Wearemoderatelyconfidentintheeffectestimate:Thetrueeffectislikely
tobeclosetotheestimateoftheeffect,butthereisapossibilitythatitissubstantiallydifferent
Low Ourconfidenceintheeffectestimateislimited:Thetrueeffectmaybesubstantiallydifferentfromtheestimateoftheeffect
VeryLow Wehaveverylittleconfidenceintheeffectestimate:Thetrueeffectislikelytobesubstantiallydifferentfromtheestimateofeffect
The evidence was then presented to members of the Guideline Development Group forconsiderationandformulationofguidelinerecommendationsforeachkeyclinicalquestion.TheGroupfurtherratedthestrengthofeachresearch-basedrecommendationusingGRADEcategories(Error!Referencesourcenot found.)11. Wheretherewasinsufficientresearchevidence to formulate a recommendation, the Guideline Development Group made aconsensusstatementorarecommendationforfurtherresearch.
Figure1.GRADEcategorisationofstrengthofrecommendation
The results of the evidence review process are presented in the following series of 10chaptersorganisedbyeachkeyclinicalquestion.TheyincludethesearchstrategiesforOvidhosteddatabasesandCINAHL frombothroundoneandroundtwo.ThesearchstrategiesarefollowedbyPRISMAchartsofthereview.ThePRISMAchartsareorganisedinto1)round
11
one searches, 2) round two searches (1st of February to the 30th ofApril 2017) only, and3)combinedresultsforbothrounds.Insomeinstances,thereareonlytwoinsteadofthreePRISMAchartsbecausetheroundtwosearchinvolvedafullsearchuptotheendofthe30thof April 2017 rather than the 1st of February to the 30th April of 2017. Furthermore, asindicated previously, the round two PRISMA charts include studies derived from othersources (those pending and not reviewed in round one, or were recommended by theGuideline Development Group for re-screening after being previously excluded in roundone,orwereidentifiedfromahandsearchofincludedstudies).Eachchapterendswithanevidencesynthesissummarytable.
3 Keyclinicalquestion1:Inworkerspresentingwithsymptomsofmentalhealthconditions,whattoolscanassistaGPinmakinganaccurate(sensitiveandspecific)diagnosisofandseverityofmentalhealthdisorders?
3.1 EvidenceReviewRoundOne
3.1.1 PICO
P Workers
I Diagnostictools
CExistingtools
OAccuratediagnosisofmentalhealthconditions
3.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
1. ((Mentaladjhealth)or(Psychiatricadj(disorder*orillness*ordisease*orcondition*or
ailment*orepisode*))or(Mentaladj(disorder*orillness*ordisease*orcondition*or
ailment*orepisode*orsufferingorstress*ordistress))or(Psychologicaladj(disorder*
orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(Depressiveadj(disorder*orillness*ordisease*orcondition*orailment*
orepisode*orsuffering))or(Moodadj(disorder*orillness*ordisease*orcondition*
orailment*orepisode*orsufferingorstress*ordistress))or(Affectiveadj(disorder*
orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(Adjustmentadj(disorder*orillness*ordisease*orcondition*orailment*
orepisode*orsufferingorstress*ordistress))or(Posttraumaticadj(disorder*or
illness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(AnxietyorstressorDepressionorVicarioustrauma)).mp.[mp=ab,hw,ti,
tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
2. (((Measure*orMeasurement*orOutcome*orAssessment*orEvaluat*orTest*or
Questionnaire*orScale*or(Mentaladjstatus)or(Psychiatr*adjrating*)or(Patientadj
12
acuity)orSeverityofIllness*or(IllnessadjSeverity)or(Healthadjstatus)orSickness
impactprofile*orIndicator*orInvestigat**orExamin*orInstrument*or
Questionnaire*orScreen*orQualityoflifeorDiagnos*orDiagnostic*orDiagnostic)
adj(tool*ortechnique*orprocedure*))ortool*or(Personalityadjscale*)or
(personalityadjinventory)orPsychometr*orSensitiv*orResponsivenessorValid*or
Reliab*orAccura*orindexorindicesorprotocol*orscore*orscoring*orguideline*or
(Clinicaladjdecision*)orSurveillanceor(timelyadjdiagnosis)orspecific*or
precis*).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
3. ((Generaladj(practi*orphysician*ordoctor))or(Familyadj(practi*orphysician*or
doctor*))or(Familyadjmedic*adj(practi*ordoctor*))or(Primaryadjcareadj(practi*
orphysician*ordoctor*))or(((Occupationalhealthadj(practi*orphysician*ordoctor*
orspecialist*))orcompany)adjphysician*)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,
fx,nm,kf,px,rx,ui,sy,tc,id,tm]
4. ((((Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*or
employmentorjobortradeor((joborworkoremploymentortrade)adjrelated)or
occupational)adj(disease*orillness*orhealth))orCompensation)adj(claim*or
compensation)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,
tm]
5. 1and2and3and4
3.1.3 SearchStrategy:CINAHL
# Query Limiters/Expanders
S1
“Mentalhealth”or(PsychiatricAND(healthordisorder*or
illness*ordisease*orcondition*orailment*orepisode*))or
(MentalAND(healthordisorder*orillness*ordisease*or
condition*orailment*orepisode*orsufferingorstress*or
distress))or(PsychologicalAND(disorder*orillness*ordisease*
orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(DepressiveAND(disorder*orillness*ordisease*or
condition*orailment*orepisode*orsuffering))or(MoodAND
(disorder*orillness*ordisease*orcondition*orailment*or
episode*orsufferingorstress*ordistress))or(AffectiveAND
(disorder*orillness*ordisease*orcondition*orailment*or
episode*orsufferingorstress*ordistress))or(AdjustmentAND
(disorder*orillness*ordisease*orcondition*orailment*or
episode*orsufferingorstress*ordistress))or((“Posttraumatic”
ORtraumatic)AND(disorder*orillness*ordisease*or
condition*orailment*orepisode*orsufferingorstress*or
distress))orAnxietyorstressorDepressionor“Vicarioustrauma”
Searchmodes-Boolean/Phrase
13
S2
Measure*orMeasurement*orOutcome*orAssessment*or
Evaluat*orTest*orQuestionnaire*orScale*or(Mentalstatus)
or(Psychiatr*rating*)or(Patientacuity)orSeverityofIllness*or
(IllnessadjSeverity)or(Healthstatus)or(Sicknessimpact
profile*)orIndicator*orInvestigat**orExamin*orInstrument*
orQuestionnaire*orScreen*or(Qualityoflife)orDiagnos*or
Diagnostic*or((Diagnosticand(tool*ortechnique*or
procedure*))ortool*or(Personalityscale*)or(personality
inventory)orPsychometr*orSensitiv*orResponsivenessor
Valid*orReliab*orAccura*orindexorindicesorprotocol*or
score*orscoring*orguideline*or(Clinicaldecision*)or
Surveillanceor(timelydiagnosis)orspecific*orprecis*
Searchmodes-Boolean/Phrase
S3
(GeneralAND(practi*orphysician*ordoctor))or(FamilyAND
(practi*orphysician*ordoctor*))or(Familymedic*(practi*or
doctor*))or(“Primarycare”AND(practi*orphysician*or
doctor*))or(“Occupationalhealth”AND(practi*orphysician*or
doctor*orspecialist*))or“companyphysician*”
Searchmodes-Boolean/Phrase
S4
Worker*orstafforemployee*orworkplace*orvocation*or
workoroccupation*oremploymentorjobortradeor“job
related”or“workrelated”or“employmentrelated”or“trade
related”or“occupationaldisease*”or“occupationalillness*”or
“occupationalhealth”orCompensationorclaim*
Searchmodes-Boolean/Phrase
S14
HADSor“MOSMentalHealthInventory”or“Depression
Screener”or“BeckDepressionInventory”or“PatientHealth
Questionnaire”orPHQor“PrimaryCareEvaluationofMental
Disorders”or“PRIME-MD”or“BRFSSAnxiety&Depression
OptionalModule”or“BRFSSMentalIllness&StigmaOptional
Module”orMADRSorMADRS-Sor“MontgomeryAsberg
DepressionRatingScale”or“NHISNon-SpecificDistressBattery”
or“AreasofWorklifeScale”orAWSor“PerceivedStressScale”
or“PSS”or“PositiveandNegativeAffectTest”or“Psychological
Well-BeingScale”or“PrimaryCarePTSDScreen”or“PC-PTSD”
Searchmodes-Boolean/Phrase
S16 sensitivityorspecificityorprecisionoraccuracyorreliability Searchmodes-Boolean/Phrase
S17 S2ORS14 Searchmodes-Boolean/Phrase
S18 S16ANDS17 Searchmodes-Boolean/Phrase
S19 S1ANDS18 Searchmodes-Boolean/Phrase
S20 S1ANDS18
Limiters-EnglishLanguage;Age
Groups:Adolescence,13-18
years,Adult,19-44years,Middle
Age,45-64years,Aged,65+
years,Aged,80andover
Searchmodes-Boolean/Phrase
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S21 S3ANDS4ANDS20 Searchmodes-Boolean/Phrase
3.1.4 Searchperiod
Databaseinceptiontothe31stofJanuary2017.
3.1.5 PRISMAround1
Embase,Medline,PsycINFOandAMED,returnedn=63recordsandCINAHL,n=630records,(Error!Referencesourcenotfound.).
Figure2.RoundonePRISMAchartforkeyclinicalquestion1
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3.2 RecommendationsarisingfromGuidelineDevelopmentGroupmeeting
Supplementsearchstrategywithexistinghigh-qualityguidelinesand/orsystematicreviewsforhighprevalentmentalhealthconditions
3.3 Evidencereviewroundtwo
3.3.1 PICO
PNorestriction
IAlltoolstodiagnoseandassessseverity;
CToolstodiagnoseandassessseverityofaparticularcondition;
OAccuratediagnosisofand/orassessmentofseverity
3.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
1. ((Mentaladjhealth)or(Psychiatricadj(disorder*orillness*ordisease*orcondition*or
ailment*orepisode*))or(Mentaladj(disorder*orillness*ordisease*orcondition*or
ailment*orepisode*orsufferingorstress*ordistress))or(Psychologicaladj(disorder*
orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(Depressiveadj(disorder*orillness*ordisease*orcondition*orailment*
orepisode*orsuffering))or(Moodadj(disorder*orillness*ordisease*orcondition*
orailment*orepisode*orsufferingorstress*ordistress))or(Affectiveadj(disorder*
orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(Adjustmentadj(disorder*orillness*ordisease*orcondition*orailment*
orepisode*orsufferingorstress*ordistress))or(Posttraumaticadj(disorder*or
illness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(AnxietyorstressorDepression)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,
fx,nm,kf,px,rx,ui,sy,tc,id,tm]
2. (((Measure*orMeasurement*orOutcome*orAssessment*orEvaluat*orTest*or
Questionnaire*orScale*or(Mentaladjstatus)or(Psychiatr*adjrating*)or(Patientadj
acuity)orSeverityofIllness*or(IllnessadjSeverity)or(Healthadjstatus)orSickness
impactprofile*orIndicator*orInvestigat**orExamin*orInstrument*or
Questionnaire*orScreen*orQualityoflifeorDiagnos*orDiagnostic*orDiagnostic)
adj(tool*ortechnique*orprocedure*))ortool*or(Personalityadjscale*)or
(personalityadjinventory)orPsychometr*orSensitiv*orResponsivenessorValid*or
Reliab*orAccura*orindexorindicesorprotocol*orscore*orscoring*orguideline*or
(Clinicaladjdecision*)orSurveillanceor(timelyadjdiagnosis)orspecific*or
precis*).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
3. ((((Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*or
employmentorjobortradeor((joborworkoremploymentortrade)adjrelated)or
occupational)adj(disease*orillness*orhealth))orCompensation)adj(claim*or
16
compensation)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,
tm]
4. 1and2and3
3.3.3 SearchStrategy:CINAHL
# Query Limiters/Expanders
S1
“Mentalhealth”or(PsychiatricAND(healthordisorder*or
illness*ordisease*orcondition*orailment*orepisode*))or
(MentalAND(healthordisorder*orillness*ordisease*or
condition*orailment*orepisode*orsufferingorstress*or
distress))or(PsychologicalAND(disorder*orillness*or
disease*orcondition*orailment*orepisode*orsufferingor
stress*ordistress))or(DepressiveAND(disorder*orillness*or
disease*orcondition*orailment*orepisode*orsuffering))or
(MoodAND(disorder*orillness*ordisease*orcondition*or
ailment*orepisode*orsufferingorstress*ordistress))or
(AffectiveAND(disorder*orillness*ordisease*orcondition*
orailment*orepisode*orsufferingorstress*ordistress))or
(AdjustmentAND(disorder*orillness*ordisease*or
condition*orailment*orepisode*orsufferingorstress*or
distress))or((“Posttraumatic”ORtraumatic)AND(disorder*or
illness*ordisease*orcondition*orailment*orepisode*or
sufferingorstress*ordistress))orAnxietyorstressor
Depression
Searchmodes-Boolean/
Phrase
S2
Measure*orMeasurement*orOutcome*orAssessment*or
Evaluat*orTest*orQuestionnaire*orScale*or(Mentalstatus)
or(Psychiatr*rating*)or(Patientacuity)orSeverityofIllness*
or(IllnessadjSeverity)or(Healthstatus)or(Sicknessimpact
profile*)orIndicator*orInvestigat**orExamin*or
Instrument*orQuestionnaire*orScreen*or(Qualityoflife)or
Diagnos*orDiagnostic*or((Diagnosticand(tool*or
technique*orprocedure*))ortool*or(Personalityscale*)or
(personalityinventory)orPsychometr*orSensitiv*or
ResponsivenessorValid*orReliab*orAccura*orindexor
indicesorprotocol*orscore*orscoring*orguideline*or
(Clinicaldecision*)orSurveillanceor(timelydiagnosis)or
specific*orprecis*
Searchmodes-Boolean/
Phrase
S4
Worker*orstafforemployee*orworkplace*orvocation*or
workoroccupation*oremploymentorjobortradeor“job
related”or“workrelated”or“employmentrelated”or“trade
related”or“occupationaldisease*”or“occupationalillness*”
or“occupationalhealth”orCompensationorclaim*
Searchmodes-Boolean/
Phrase
S14HADSor“MOSMentalHealthInventory”or“Depression
Screener”or“BeckDepressionInventory”or“PatientHealth
Searchmodes-Boolean/
Phrase
17
Questionnaire”orPHQor“PrimaryCareEvaluationofMental
Disorders”or“PRIME-MD”or“BRFSSAnxiety&Depression
OptionalModule”or“BRFSSMentalIllness&StigmaOptional
Module”orMADRSorMADRS-Sor“MontgomeryAsberg
DepressionRatingScale”or“NHISNon-SpecificDistress
Battery”or“AreasofWorklifeScale”orAWSor“Perceived
StressScale”or“PSS”or“PositiveandNegativeAffectTest”or
“PsychologicalWell-BeingScale”or“PrimaryCarePTSDScreen”
or“PC-PTSD”
S16 sensitivityorspecificityorprecisionoraccuracyorreliabilitySearchmodes-Boolean/
Phrase
S17 S2ORS14Searchmodes-Boolean/
Phrase
S18 S16ANDS17Searchmodes-Boolean/
Phrase
S19 S1ANDS18Searchmodes-Boolean/
Phrase
S20 S1ANDS18
Limiters-EnglishLanguage;
AgeGroups:Adolescence,13-
18years,Adult,19-44years,
MiddleAge,45-64years,Aged,
65+years,Aged,80andover
Searchmodes-Boolean/
Phrase
S21 S4ANDS20Searchmodes-Boolean/
Phrase
3.3.4 Searchperiod
Fromthe1stofFebruary2017tothe30thofApril2017.
3.3.5 PRISMARound2
Embase,Medline,PsycINFOandAMEDreturnedn=144recordsandCINAHLreturnedn=32
records(Error!Referencesourcenotfound.).
18
Figure3.RoundtwoPRISMAchartofkeyclinicalquestion1updates
CombinedresultsfromroundoneandtwoareshowninFigure4.
19
Figure4.CombinedroundoneandroundtwoPRISMAchartforkeyclinicalquestion1
3.4 ExistingGuidelinesandSystematicReviewsforKeyclinicalquestion1
3.4.1 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting
Supplementsearchstrategywithexistinghigh-qualityguidelinesand/orsystematicreviewsforhighprevalentmentalhealthconditions
3.4.2 PICO
PNorestriction
IAlltoolstodiagnoseandassessseverity;
CToolstodiagnoseandassessseverityofaparticularcondition;
OAccuratediagnosisofand/orassessmentofseverity
20
3.4.3 Guidelines
Table3.Searchstrategyforexistingguidelinesforkeyclinicalquestion1
GuidelineResource SearchStrategyandLimitersGuidelinesInternationalNetwork(GIN) MentalDisorders(Meshterms),English,
Diagnosis(Note:screenedfordiagnosis)
NationalGuidelineClearinghouse/psychology ListReview
NationalGuidelineClearinghouse/psychiatric ListReview
NationalGuidelineClearinghouse Depression
NHMRCClinicalGuidelinesPortal ListReview
TheNICE/Mentalhealthandbehavioural
conditions
ListReview
TheNICE/Injuries,accidentsandwounds ListReview
TheRoyalAustralianCollegeofGeneral
Practitioners(RACGP)
ListReview
TheRoyalAustralianandNewZealandCollege
ofPsychiatrists(RANZCP)
Listreview
ScottishIntercollegiateGuidelinesNetwork(SIGN)
Listreview
ScottishIntercollegiateGuidelinesNetwork(SIGN)
Mentalhealth(keyword)
TheWHO Listreview
TheWHO/Mentalhealthandsubstanceabuse Listreview
Google Depressionguideline
anxietyguidelines
3.4.3.1 Searchperiod
Originalsearch:uptothe25thofMay2017
Updatedsearch:3rdofJuly2017
3.4.3.2 PRISMA-Guidelines
21
Figure5.PRISMAflowchartofguidelinesforkeyclinicalquestion1
Table4.Guidelineswithrecommendationsaddressingkeyclinicalquestion1
GuidelineTitle GuidelineAuthor Date AGREEscore
Anxietydisorders(DRAFT) RANZCP 2017 TBA
Depressioninadultswithachronicphysicalhealthproblem:
recognitionandmanagement(CG91)12
NICE 2009 100%
Depression:TheNICEguidelineonthetreatmentand
managementofdepressioninadults(CG90)13
NICE 2016 92%
Commonmentalhealthproblems:identificationand
pathwaystocare(CG123)14
NICE 2011 92%
Alcohol-usedisorders:diagnosis,assessmentand
managementofharmfuldrinkingandalcoholdependence
(CG115)15
NICE 2011 83%
Generalisedanxietydisorderandpanicdisorderinadults
(CG113)16
NICE 2011 83%
22
3.4.4 Systematicreviews
Table5.Searchstrategyforexistingsystematicreviewsforkeyclinicalquestion1
SystematicReviewResource SearchStrategyandLimitersCochraneLibrary Mentalhealth(Meshterm),subheading
diagnosis
Depression,diagnosis
Anxiety,diagnosis
Stress,diagnosis
CochraneReviews/Commonmentaldisorders
reviewgroup
Listreview
CochraneReviews/topicmentalhealth Listreview
CampbellCollaboration Listreview
JoannaBriggsInstitute Mentalhealth-Listreview
3.4.4.1 Searchperiod
Fromthe1stofFebruary2017tothe30thofApril2017.
3.4.4.2 Outcome
Thesearchreturnednorecords.
3.5 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion1
Table6.Keyclinicalquestion1literaturesearchresultsandimplicationsarisingfromsearchstrings
usedinrelationtowork
EvidenceReviewRound
OriginalKeyclinicalquestion1.Inworkerspresentingwith
symptomsofmental
healthconditions,what
toolscanassistaGPin
makinganaccurate
(sensitiveandspecific)
diagnosisofand
severityofmental
healthdisorders?
Ovidimplication CINAHLimplication
OVIDcount CINAHLcount
R1 - Mentalhealth
conditions(included
vicarioustrauma)
- Work-relatedness
- Generalpractice
- Tools
Workinthe
compensable
setting
Work 63 630
Ifwork-
relatedness
searchstringhad
beencorrected
to“work”
Work 176676
Noimpact
23
EvidenceReviewRound
OriginalKeyclinicalquestion1.Inworkerspresentingwith
symptomsofmental
healthconditions,what
toolscanassistaGPin
makinganaccurate
(sensitiveandspecific)
diagnosisofand
severityofmental
healthdisorders?
Ovidimplication CINAHLimplication
OVIDcount CINAHLcount
R2 - Nochangetokeyclinicalquestion
- Mentalhealth
conditions
(vicarioustraumaremoved)
- Generalpracticeremoved
- Work-relatedness- Tools- Feb-April2017
Workinthe
compensable
setting
work 144 32
Ifwork-
relatedness
searchstringhad
beencorrected
to“work”
Work 5937 Noimpact
Searchfor
guidelines
and
systematic
reviews
Guidelinesn=69
Systematicreviewsn=0
EvidenceReviewGroupRecommendation:ForKeyclinicalquestion1,thelargenumberof
hitsinOvidthatwouldhaveoccurredasaresultofthesearchstringerrorcorrectionwould
havemadethesearchunfeasible.Ourrecommendationistoacceptthefinal
recommendationasperGuidelineDevelopmentGroupmeeting3.
3.6 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:
Keyclinicalquestion1 Altogether, 46 unique tools, including different versions of some of the tools, were
identifiedfromin42studiesand40ofthesearelistedinTable7.Twotoolsnotlistedinthe
table were generic tools which were used for unspecified work-related mental health
conditions; theShort Form-36 Items (SF-36)-mentalhealth component 17 and theGeneral
HealthQuestionnaire-12 item (GHQ-12) 18. The commonlyused tools ranged frommostly
self-completedpatientquestionnairestotrainedclinicianadministereddiagnosticinterview
schedules (e.g. MINI International Neuropsychiatric Interview (MINI), Watson’s PTSD
Interview).
24
Table7.Commonlyusedwork-relatedMHCassessmenttools
MHC Tools Study
Anxiety
Anxietydisordersinterviewschedule(ADIS) Tehranietal.200219
BeckAnxietyInventory(BAI) Fangetal.200820
FritzandGeorge200221
Sussneretal.200622
HamiltonAnxietyScale(HAMA) Kozaric-Kovacicetal.200123
Sheehan’sPatientRatedAnxietyScale(Sheehan) Tsutsumietal.200524
PatientHealthQuestionnaire-9(PHQ-9) Rauetal.201025
CompositeInternationalDiagnosticInterview(CIDI) Langeraketal.201226
Four-DimensionalSymptomQuestionnaire(4DSQ) Langeraketal.201226
Vroegeetal.201527
GeneralHealthQuestionnaire(GHQ-12) Bennettetal.200528
HospitalAnxietyandDepressionScale(HADS) Cameronetal.200829
Ioannouetal201630
PallantandTennant200731
MINIInternationalNeuropsychiatricInterview(MINI) Choleraetal.201432
DepressionAnxietyStressScales(DASS) Nieuwenhuijsenetal200333
SymptomChecklist90-Revised(SCL-90R) Simonetal199034
Tehranietal.200219
Zhengxueetal.201635
TemplerDeathAnxietyScale HuntandRosenthal200036
Depressio
n
BeckDepressionInventory(BDI) Fangetal.200820
Leeetal.201337
Tehranietal.200219
BeckDepressionInventory-amended(BDI-IA) Harris&D'Eon2008a38
BeckDepressionInventory-II(BDI-II) Cameronetal.200829
Gardneretal.201239
Harris&D'Eon200838
Linetal.201040
Sussneretal.200622
Williams201041
CenterforEpidemiologicStudiesDepressionScale(CES-D)
FritzandGeorge200221
Rauetal.201025
Bordersetal.201042
HamiltonDepressionRatingScale(HAM-D) Harris&D'Eon200838
Kozaric-Kovacicetal.200123
MINIInternationalNeuropsychiatricInterview(MINI) Volkeretal.201643
PatientHealthQuestionnaire-9(PHQ-9) Choleraetal.201432
Letvaketal.201244
Smithetal.200745
Volkeretal.201643
ZungSelf-RatingDepressionScale Tsutsumietal.200524
Four-DimensionalSymptomQuestionnaire(4DSQ) Langeraketal.201226
Vroegeetal.201527
GeneralHealthQuestionnaire(GHQ-12) Bennettetal.200528
25
MichélsenandBildt200346
HospitalAnxietyandDepressionScale(HADS) Cameronetal.200829
Ioannouetal201630
MINIInternationalNeuropsychiatricInterview(MINI) Choleraetal.201432
DepressionAnxietyStressScales(DASS) Nieuwenhuijsenetal200333
SymptomChecklist90-Revised(SCL-90R) Simonetal199034
Tehranietal.200219
Zhengxueetal.201635
PTSD
Clinician'sAdministered/AssessmentofPTSDScale(CAPS)
KochandHaring200847
Matuskoetal201348
Tehranietal.200219
DetailedAssessmentofPosttraumaticStress Rubenzer200949
GeneralHealthQuestionnaire(GHQ) Tehranietal.200219
GeneralHealthQuestionnaire-28(GHQ-28) Cothereauetal.200450
ImpactofEventScale-Revised(IES-R) DunkleyandWhelan200651
Tehranietal.200219
Impactofeventsscale-extendedversion(IES-E) Tehranietal.200219
Impactofeventsscale(IES) Tehranietal.200219
MorelEmotionalNumbingTest Rubenzer200949
Penninventory Tehranietal.200219
PosttraumaticStressDisorderChecklist-CivilianVersion(PCL-C)
Gardneretal.201239
Harrisetal.200852
Ioannouetal201630
Smithetal.200745
PTSDsymptomscale(PSS) Tehranietal.200219
Structuredclinicalinterviewfordiagnosis(SCID) Tehranietal.200219
TraumaAttachmentandBeliefScale(TABS) DunkleyandWhelan200651
TraumaSymptomInventory Rubenzer200949
Watson’sPTSDInterview Kozaric-Kovacicetal.200123
Stress
DerogatisStressProfile Russelletal199553
GlobalStressQuestionnaire Irnizaetal.201454
BriefSymptomInventory(BSI) Wesselingetal.201055
GeneralHealthQuestionnaire(GHQ-12) Rossetal200956
BasicSymptomInventory-18(BSI-18) Hopkins-Chadwick200557
DepressionAnxietyStressScales(DASS) Nieuwenhuijsenetal200333
GeneralHealthQuestionnaire(GHQ-28) DehghanandTaeb201358
Ofthe42studies,fivewereDiagnosticTestAccuracy(DTA)studieswhichmettheinclusion
criteriaforreviewofsensitivityandspecificityindepression263243,anxiety2633andPTSD39.
The five studies met the quality criteria for DTA across most items of the QUADAS tool
(Table8).Theywere,ingeneral,pooronreporting:
• Item10-Weretheindextestresultsinterpretedwithoutknowledgeoftheresultsofthereferencestandard?
26
• Item11-Werethereferencestandardresultsinterpretedwithoutknowledgeoftheresultsoftheindextest?
• Item13-Wereuninterpretable/intermediatetestresultsreported?
ThestudiesinvestigatedthePHQ-93243,4DSQ26,DASS33andPCL-C39.Copiesofthetools
areappendedinAppendix2toAppendix5.
Table8.Qualityassessmentofstudiesofdiagnostictestaccuracy
QUADASItems* Choleraetal.20
1432
Gardn
eretal.201
239
Lang
eraketal.201
226
Nieuw
enhu
ijsen
etal
2003
33
Volkeretal.20
1643
1. Representativepatientspectrum n y y y y
2. Descriptionofselectioncriteria y y y y y
3. Correctclassificationwithreferencestandard y y y y y
4. Adequatetimebetweenreferencestandardandindextest y y u y y
5. Diagnosisverificationagainstreferencestandard y y y y y
6. Allpatientsreceivedreferencestandard y y y y y
7. Referencestandardandindextestindependence y y y y y
8. Indextestreplication y y y y y
9. Referencestandardreplication y y y y y
10. Independentindextestinterpretation y u u u y
11. Independentreferencestandardinterpretation y u u u u
12. Dataavailability y y y u u
13. Reportingofuninterpretableresults y u u u n
14. Explanationforstudywithdrawals y y y n y*ForfulldetailsofinstrumentitemsseeAppendix1.Responses:n=no;y=yes;u=unclear
Sensitivityandspecificitysummarypointmeasuresand95%CIforthePHQ-9,DASS,4DSQ
andPCL-Carepresented inevidenceTable9. All the toolsdemonstratedgoodsensitivity
and specificity at positive screening cut-offs indicated in summary evidence Table 9. The
toolsareshortandcanbecompletedbythepatient.ThePHQ-9andthePCL-Carefreeto
use while the DASS and 4DSQ require a licencing fee for commercial use.
27
Table9.GRADEEvidenceProfileTable:Inworkerspresentingwithsymptomsofmentalhealthconditions,whattoolscanassistaGPinmakinganaccurate(sensitiveandspecific)diagnosisofandseverityofmentalhealthdisorders?
MHC IndexTool*
Referencestandard*
QualityAssessment(GRADECriteria) Positivecut offscore
Sensitivity,%
Specificity,%
GRADENo.ofstudies
StudyDesign
RiskofBias
Inconsistency Indirectness Imprecision OtherConsiderations
No.ofpatients
Depressio
n
PHQ-9
MINI 132 Cross-sectional
None None Notserious Notserious IncludedparticipantswithHIV
397 10 79(64,89) 83(79,87) HIGH
PHQ-9
MINI 143 Cross-section(inanRCT)
Notserious
Notserious Notserious Notserious Independenceininterpretationofindexandreftestunclear
170 10 86(71,95) 78(70,85) MOD
DASS CIDI 133 Cohort Serious None None None Independenceininterpretationofindexandreftestunclear,noreportofuninterpretableresults
198 12 91(71,98) 46(38,54) MOD
4DSQ
CIDI 126 Cross-sectional
none none notserious serious Independenceininterpretationofindexandreftestunclear
230 3 73(64,81) 75(67,83) MOD
Anxiety
DASS CIDI 133 Cohort Serious None None None Independenceininterpretationofindexandreftestunclear,noreportofuninterpretableresults
198 5 92(80,98) 40(32,48) MOD
28
4DSQ
CIDI 126 Cross-sectional
none none notserious serious Independenceininterpretationofindexandreftestunclear
230 7 74(66,81) 71(61,81) MOD
PTSD
PCL-C DSM-IV 139 Cross-sectional
serious none notserious None Independenceininterpretationofindexandreftestunclear
132 50 90(79,96) 79(59,92) MOD
Acronyms: 4DSQ:Four-DimensionalSymptomQuestionnaire;CIDI:CompositeInternationalDiagnosticInterview;DASS:DepressionAnxietyStressScales;DSM-IV:DiagnosticandStatisticalManualofMentalDisorders,4thEdition;MINI:MINIInternationalNeuropsychiatricInterview;PCL-C:PosttraumaticStressDisorderChecklist-CivilianVersion;PHQ-9:Patienthealthquestionnaire9-Item
29
After review of the round one preliminary findings, the Guideline Development Group
recommended supplementation with existing clinical practice guidelines and systematic
reviews.Therewere30guidelinesoutof66whichcoveredthescopeofkeyclinicalquestion
1.These,andtheircorrespondingaggregatedAGREEscores,arepresentedinthefollowing
Table10.Thescopeoftheguidelinescoveredmentalhealthconditionswithoutrestriction
to work. That, notwithstanding the guidelines, made recommendations or general non-
prescriptiveguidanceonpotentialtoolsthatcouldbeconsideredinthecourseofdiagnosis
andassessmentof severityofmentalhealthconditions.Tools for thediagnosisofanxiety
disorders were discussed in three guidelines; NICE 2016 CG9059, NICE 2011 GAD
16 and
RANZCP2017(Draft)60.
TheNICEclinicalguidelinefordepression59 includedareviewoftheHospitalAnxietyand
DepressionScale(HADS)61basedon21studies.TheHADSmeasuresdepressionandanxiety
inpeoplewithphysicalhealthproblems.
The RANZCP 2017 draft guideline60 recommended using either the Penn State Worry
Questionnaire-3(PSWQ-3)ortheGeneralizedAnxietyDisorder-7(GAD-7).ThePSWQ-3isa
three-item generalised anxiety disorder-specific questionnaire62, and its validity in other
types of anxiety may be uncertain. However, It would be a difficult and unfeasible
expectation forGPs tousespecific screening tools foreach typeofanxietydisorder. The
GAD-7isaseven–itemscreenerforsymptomsofgeneralisedanxietydisorder63andmore
likelytoattractinterest.
The NICE 2011 clinical guideline for alcohol use disorder15 provided guidance on the
following tools for use in identifying peoplewith alcohol or substance use disorders:TheAlcohol Use Disorders Inventory Test (AUDIT) (alcohol only), the Severity of Alcohol
Dependence Questionnaire (SADQ) (alcohol only), the Leeds Dependence Questionnaire
(LDQ),andtheAlcoholProblemsQuestionnaire(APQ)(alcoholonly).
Onthebasisofrecommendationbyhighqualityclinicalguidelines,theGAD-7,AUDIT,SADQ
andLDQ(Appendix6toAppendix9)wereshortlistedforconsiderationforthekeyclinical
question1.
Table10.Listofguidelinesaddressingkeyclinicalquestion1
GuidelineTitle GuidelineAuthor/Publisher
Date AGREEscore
Anxietydisorders(DRAFT) RANZCP 2017 TBA
Depressioninadultswithachronicphysicalhealthproblem:recognitionandmanagement(CG91)12
NICE 2009 100%
Depression:TheNICEguidelineonthetreatmentandmanagementofdepressioninadults(CG90)13
NICE 2016 92%
Commonmentalhealthproblems:identificationandpathwaystocare(CG123)14
NICE 2014 92%
30
Alcohol-usedisorders:diagnosis,assessmentandmanagementofharmfuldrinkingandalcoholdependence(CG115)15
NICE 2011 83%
Generalisedanxietydisorderandpanicdisorderinadults(CG113)16
NICE 2011 83%
Clinicalpracticeguidelineforthepreventionandtreatmentofsuicidalbehaviour64
GalicianAgencyHTA 2012 92%
Screeningfordepressioninchildrenandadolescents:U.S.PreventiveServicesTaskForcerecommendationstatement65
DepartmentofVeteran's
Affairs
2016 92%
Clinicalpracticeguidelineforthemanagementofsubstanceusedisorders66
DepartmentofVeteran's
Affairs
2015 83%
Practiceguidelineforthepsychiatricevaluationofadults67 AmericanPsychiatric
Association
2015 75%
Clinicalpracticeguidelineforassessmentandmanagementofpatientsatriskforsuicide68
DepartmentofVeterans
Affairs
2013 75%
Recommendationsonscreeningfordepressioninadults69 CanadianTaskForceon
PreventiveHealthCare
2013 75%
Practiceguidelineforthetreatmentofpatientswithsubstanceusedisorders70
WorkGrouponSubstance
UseDisorders;American
PsychiatricAssociation
2006 75%
Clinicalpracticeguidelineformanagementofmajordepressivedisorder(MDD)71
DepartmentofVeterans
Affairs
2016 75%
Screeningfordepressioninadults72 USPreventiveServices
Taskforce
2016 75%
UpdateoftheAustralianGuidelinesforthetreatmentofAcuteStressDisorderandPosttraumaticStressDisorder73
PhoenixAustralia 2013 75%
Adultdepressioninprimarycare.Bloomington(MN)74 InstituteforClinical
SystemsImprovement
(ICSI)
2016 67%
Clinicalpracticeguidelinesformooddisorders75 RANZCP 2015 67%
Depression76 MoHSingapore 2012 67%
Diagnosisandtreatmentofdepressioninadults77 KaiserPermanente 2012 67%
Clinicalpracticeguidelineformanagementofpost-traumaticstress78
DepartmentofVeterans
Affairs(VaDoD)
2010 67%
Practiceguidelineforthetreatmentofpatientswithpanicdisorder2ndedition79
AmericanPsychiatric
Association
2010 67%
Clinicalpracticeguidelinesforthemanagementofanxiety,posttraumaticstressandobsessive-compulsivedisorders80
CanadianAnxiety
GuidelinesInitiativeGroup
2014 58%
Guidelinesforpreventiveactivitiesingeneralpractice81 RACGP 2016 50%
IdentifyingandManagingPosttraumaticStressDisorder82 Warneretal 2013 50%
ThePhysician’sRoleinManagingAcuteStressDisorder83 Kavanetal 2012 42%
Primarycarediagnosisandmanagementofadultswithdepression84
MichiganQuality
ImprovementConsortium
2016 33%
Screening,DiagnosisandReferralforSubstanceUseDisorders85
MichiganQuality
ImprovementConsortium
2015 33%
ProblemDrinking86 BritishColumbiaGuidelines
andProtocolsAdvisory
Committee
2011[Revised:
April1,2013
25%
DiagnosisofAnxietyDisordersinPrimaryCare87 Ebelletal 2008 8%
31
4 Keyclinicalquestion2:Inpatientswithadiagnosedmentalhealthcondition,whatmethodsareeffectiveatindicatingtheprobabilitythatthediagnosedmentalhealthconditionhasarisenasaresultofwork?
4.1 Evidencereviewroundone
4.1.1 PICO
PPatientswhoattendprimarycarewithadiagnosedmentalhealthcondition
IInvestigativemethods,corroboratinginformation
CExistingscalesandmethods
OAccurateassessmentofthecontributionofworktothementalhealthcondition
4.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED 1. ((Mentaladjhealth)or(Psychiatricadj(disorder*orillness*ordisease*orcondition*or
ailment*orepisode*))or(Mentaladj(disorder*orillness*ordisease*orcondition*or
ailment*orepisode*orsufferingorstress*ordistress))or(Psychologicaladj(disorder*
orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(Depressiveadj(disorder*orillness*ordisease*orcondition*orailment*
orepisode*orsuffering))or(Moodadj(disorder*orillness*ordisease*orcondition*
orailment*orepisode*orsufferingorstress*ordistress))or(Affectiveadj(disorder*
orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(Adjustmentadj(disorder*orillness*ordisease*orcondition*orailment*
orepisode*orsufferingorstress*ordistress))or(Posttraumaticadj(disorder*or
illness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(AnxietyorstressorDepressionorVicarioustrauma)).mp.[mp=ab,hw,ti,
tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
2. (((Measure*orMeasurement*orOutcome*orAssessment*orEvaluat*orTest*or
Questionnaire*orScale*or(Mentaladjstatus)or(Psychiatr*adjrating*)or(Patientadj
acuity)orSeverityofIllness*or(IllnessadjSeverity)or(Healthadjstatus)orSickness
impactprofile*orIndicator*orInvestigat**orExamin*orInstrument*or
Questionnaire*orScreen*orQualityoflifeorDiagnos*orDiagnostic*orDiagnostic)
adj(tool*ortechnique*orprocedure*))ortool*or(Personalityadjscale*)or
(personalityadjinventory)orPsychometr*orSensitiv*orResponsivenessorValid*or
Reliab*orAccura*orindexorindicesorprotocol*orscore*orscoring*orguideline*or
(Clinicaladjdecision*)orSurveillanceor(timelyadjdiagnosis)orspecific*or
precis*).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
3. ((Generaladj(practi*orphysician*ordoctor))or(Familyadj(practi*orphysician*or
doctor*))or(Familyadjmedic*adj(practi*ordoctor*))or(Primaryadjcareadj(practi*
orphysician*ordoctor*))or(((Occupationalhealthadj(practi*orphysician*ordoctor*
32
orspecialist*))orcompany)adjphysician*)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,
fx,nm,kf,px,rx,ui,sy,tc,id,tm]
4. ((((Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*or
employmentorjobortradeor((joborworkoremploymentortrade)adjrelated)or
occupational)adj(disease*orillness*orhealth))orCompensation)adj(claim*or
compensation)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,
tm]
5. 1and2and3and4
4.1.3 SearchStrategy:CINAHL
# Query Limiters/Expanders
S1
“Mentalhealth”or(PsychiatricAND(healthordisorder*or
illness*ordisease*orcondition*orailment*orepisode*))or
(MentalAND(healthordisorder*orillness*ordisease*or
condition*orailment*orepisode*orsufferingorstress*or
distress))or(PsychologicalAND(disorder*orillness*or
disease*orcondition*orailment*orepisode*orsufferingor
stress*ordistress))or(DepressiveAND(disorder*orillness*or
disease*orcondition*orailment*orepisode*orsuffering))or
(MoodAND(disorder*orillness*ordisease*orcondition*or
ailment*orepisode*orsufferingorstress*ordistress))or
(AffectiveAND(disorder*orillness*ordisease*orcondition*
orailment*orepisode*orsufferingorstress*ordistress))or
(AdjustmentAND(disorder*orillness*ordisease*or
condition*orailment*orepisode*orsufferingorstress*or
distress))or((“Posttraumatic”ORtraumatic)AND(disorder*or
illness*ordisease*orcondition*orailment*orepisode*or
sufferingorstress*ordistress))orAnxietyorstressor
Depressionor“Vicarioustrauma”
Searchmodes-Boolean/
Phrase
S2
Measure*orMeasurement*orOutcome*orAssessment*or
Evaluat*orTest*orQuestionnaire*orScale*or(Mentalstatus)
or(Psychiatr*rating*)or(Patientacuity)orSeverityofIllness*
or(IllnessadjSeverity)or(Healthstatus)or(Sicknessimpact
profile*)orIndicator*orInvestigat**orExamin*or
Instrument*orQuestionnaire*orScreen*or(Qualityoflife)or
Diagnos*orDiagnostic*or((Diagnosticand(tool*or
technique*orprocedure*))ortool*or(Personalityscale*)or
(personalityinventory)orPsychometr*orSensitiv*or
ResponsivenessorValid*orReliab*orAccura*orindexor
indicesorprotocol*orscore*orscoring*orguideline*or
(Clinicaldecision*)orSurveillanceor(timelydiagnosis)or
specific*orprecis*
Searchmodes-Boolean/
Phrase
33
S3
(GeneralAND(practi*orphysician*ordoctor))or(FamilyAND
(practi*orphysician*ordoctor*))or(Familymedic*(practi*or
doctor*))or(“Primarycare”AND(practi*orphysician*or
doctor*))or(“Occupationalhealth”AND(practi*orphysician*
ordoctor*orspecialist*))or“companyphysician*”
Searchmodes-Boolean/
Phrase
S4
Worker*orstafforemployee*orworkplace*orvocation*or
workoroccupation*oremploymentorjobortradeor“job
related”or“workrelated”or“employmentrelated”or“trade
related”or“occupationaldisease*”or“occupationalillness*”
or“occupationalhealth”orCompensationorclaim*
Searchmodes-Boolean/
Phrase
S14
HADSor“MOSMentalHealthInventory”or“Depression
Screener”or“BeckDepressionInventory”or“PatientHealth
Questionnaire”orPHQor“PrimaryCareEvaluationofMental
Disorders”or“PRIME-MD”or“BRFSSAnxiety&Depression
OptionalModule”or“BRFSSMentalIllness&StigmaOptional
Module”orMADRSorMADRS-Sor“MontgomeryAsberg
DepressionRatingScale”or“NHISNon-SpecificDistress
Battery”or“AreasofWorklifeScale”orAWSor“Perceived
StressScale”or“PSS”or“PositiveandNegativeAffectTest”or
“PsychologicalWell-BeingScale”or“PrimaryCarePTSDScreen”
or“PC-PTSD”
Searchmodes-Boolean/
Phrase
S16 sensitivityorspecificityorprecisionoraccuracyorreliabilitySearchmodes-Boolean/
Phrase
S17 S2ORS14Searchmodes-Boolean/
Phrase
S18 S16ANDS17Searchmodes-Boolean/
Phrase
S19 S1ANDS18Searchmodes-Boolean/
Phrase
S20 S1ANDS18
Limiters-EnglishLanguage;
AgeGroups:Adolescence,13-
18years,Adult,19-44years,
MiddleAge,45-64years,
Aged,65+years,Aged,80
andover
Searchmodes-Boolean/
Phrase
S21 S3ANDS4ANDS20Searchmodes-Boolean/
Phrase
4.1.4 Searchperiod
Databaseinceptiontothe31stofJanuary2017.
34
4.1.5 PRISMAroundone
Embase,Medline,PsycINFOandAMEDreturnedn=63recordsandCINAHLreturnedn=630
records(Error!Referencesourcenotfound.).
Figure6.RoundonePRISMAchartforkeyclinicalquestion2Figure6.RoundonePRISMAchartforkeyclinicalquestion2
4.2 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting
Expandsearchinclusioncriteriatoincludeindicatorsandtoolsformentalhealthconditionsarisingoutofworkbutnotrestrictedtothecontextofgeneralpractice.
4.3 Evidencereviewroundtwo
4.3.1 PICO
PPatientswithadiagnosedmentalhealthcondition
IAllmethods
CAllmethodsforaparticularcondition
OAssessmentofprobabilityofwork-relatedness
35
4.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
1. ((Mentaladjhealth)or(Psychiatricadj(disorder*orillness*ordisease*orcondition*or
ailment*orepisode*))or(Mentaladj(disorder*orillness*ordisease*orcondition*or
ailment*orepisode*orsufferingorstress*ordistress))or(Psychologicaladj(disorder*
orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(Depressiveadj(disorder*orillness*ordisease*orcondition*orailment*
orepisode*orsuffering))or(Moodadj(disorder*orillness*ordisease*orcondition*
orailment*orepisode*orsufferingorstress*ordistress))or(Affectiveadj(disorder*
orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(Adjustmentadj(disorder*orillness*ordisease*orcondition*orailment*
orepisode*orsufferingorstress*ordistress))or(Posttraumaticadj(disorder*or
illness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(AnxietyorstressorDepression)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,
fx,nm,kf,px,rx,ui,sy,tc,id,tm]
2. (((Measure*orMeasurement*orOutcome*orAssessment*orEvaluat*orTest*or
Questionnaire*orScale*or(Mentaladjstatus)or(Psychiatr*adjrating*)or(Patientadj
acuity)orSeverityofIllness*or(IllnessadjSeverity)or(Healthadjstatus)orSickness
impactprofile*orIndicator*orInvestigat**orExamin*orInstrument*or
Questionnaire*orScreen*orQualityoflifeorDiagnos*orDiagnostic*orDiagnostic)
adj(tool*ortechnique*orprocedure*))ortool*or(Personalityadjscale*)or
(personalityadjinventory)orPsychometr*orSensitiv*orResponsivenessorValid*or
Reliab*orAccura*orindexorindicesorprotocol*orscore*orscoring*orguideline*or
(Clinicaladjdecision*)orSurveillanceor(timelyadjdiagnosis)orspecific*or
precis*).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
3. ((((Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*or
employmentorjobortradeor((joborworkoremploymentortrade)adjrelated)or
occupational)adj(disease*orillness*orhealth))orCompensation)adj(claim*or
compensation)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,
tm]
4. 1and2and3
36
4.3.3 SearchStrategy:CINAHL
# Query Limiters/Expanders
S1
“Mentalhealth”or(PsychiatricAND(healthordisorder*or
illness*ordisease*orcondition*orailment*orepisode*))or
(MentalAND(healthordisorder*orillness*ordisease*or
condition*orailment*orepisode*orsufferingorstress*or
distress))or(PsychologicalAND(disorder*orillness*or
disease*orcondition*orailment*orepisode*orsufferingor
stress*ordistress))or(DepressiveAND(disorder*orillness*or
disease*orcondition*orailment*orepisode*orsuffering))or
(MoodAND(disorder*orillness*ordisease*orcondition*or
ailment*orepisode*orsufferingorstress*ordistress))or
(AffectiveAND(disorder*orillness*ordisease*orcondition*
orailment*orepisode*orsufferingorstress*ordistress))or
(AdjustmentAND(disorder*orillness*ordisease*or
condition*orailment*orepisode*orsufferingorstress*or
distress))or((“Posttraumatic”ORtraumatic)AND(disorder*or
illness*ordisease*orcondition*orailment*orepisode*or
sufferingorstress*ordistress))orAnxietyorstressor
Depression
Searchmodes-Boolean/
Phrase
S2
Measure*orMeasurement*orOutcome*orAssessment*or
Evaluat*orTest*orQuestionnaire*orScale*or(Mentalstatus)
or(Psychiatr*rating*)or(Patientacuity)orSeverityofIllness*
or(IllnessadjSeverity)or(Healthstatus)or(Sicknessimpact
profile*)orIndicator*orInvestigat**orExamin*or
Instrument*orQuestionnaire*orScreen*or(Qualityoflife)or
Diagnos*orDiagnostic*or((Diagnosticand(tool*or
technique*orprocedure*))ortool*or(Personalityscale*)or
(personalityinventory)orPsychometr*orSensitiv*or
ResponsivenessorValid*orReliab*orAccura*orindexor
indicesorprotocol*orscore*orscoring*orguideline*or
(Clinicaldecision*)orSurveillanceor(timelydiagnosis)or
specific*orprecis*
Searchmodes-Boolean/
Phrase
S4
Worker*orstafforemployee*orworkplace*orvocation*or
workoroccupation*oremploymentorjobortradeor“job
related”or“workrelated”or“employmentrelated”or“trade
related”or“occupationaldisease*”or“occupationalillness*”
or“occupationalhealth”orCompensationorclaim*
Searchmodes-Boolean/
Phrase
S14
HADSor“MOSMentalHealthInventory”or“Depression
Screener”or“BeckDepressionInventory”or“PatientHealth
Questionnaire”orPHQor“PrimaryCareEvaluationofMental
Disorders”or“PRIME-MD”or“BRFSSAnxiety&Depression
OptionalModule”or“BRFSSMentalIllness&StigmaOptional
Module”orMADRSorMADRS-Sor“MontgomeryAsberg
Searchmodes-Boolean/
Phrase
37
DepressionRatingScale”or“NHISNon-SpecificDistress
Battery”or“AreasofWorklifeScale”orAWSor“Perceived
StressScale”or“PSS”or“PositiveandNegativeAffectTest”or
“PsychologicalWell-BeingScale”or“PrimaryCarePTSDScreen”
or“PC-PTSD”
S16 sensitivityorspecificityorprecisionoraccuracyorreliabilitySearchmodes-Boolean/
Phrase
S17 S2ORS14Searchmodes-Boolean/
Phrase
S18 S16ANDS17Searchmodes-Boolean/
Phrase
S19 S1ANDS18Searchmodes-Boolean/
Phrase
S20 S1ANDS18
Limiters-EnglishLanguage;
AgeGroups:Adolescence,
13-18years,Adult,19-44
years,MiddleAge,45-64
years,Aged,65+years,
Aged,80andover
Searchmodes-Boolean/
Phrase
S21 S4ANDS20Searchmodes-Boolean/
Phrase
4.3.4 Searchperiod
Fromthe1stofFebruary2017tothe30
thofApril2017.
4.3.5 PRISMAround2
Embase,Medline,PsycINFOandAMEDreturnedn=144recordsandCINAHLreturnedn=32
records.
38
Figure7.RoundtwoPRISMAchartofkeyclinicalquestion2updates
39
Figure8.CombinedroundoneandroundtwoPRISMAchartforkeyclinicalquestion2
4.4 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion2
Table11.Keyclinicalquestion2literaturesearchresultsandimplicationsarisingfromsearchstrings
usedinrelationtowork
EvidenceReviewRound
OriginalKeyclinicalquestion2.Inpatientswithadiagnosed
mentalhealth
condition,what
methodsareeffective
atindicatingthe
probabilitythatthe
diagnosedmental
healthconditionhas
Ovidimplication CINAHLimplication
OVIDcount CINAHLcount
40
arisenasaresultof
work?R1 - Mentalhealth
conditions(included
vicarioustrauma)
- Work-relatedness
- Generalpractice
- Tools
Workinthe
compensable
setting
work 63 630
Ifwork-
relatedness
searchstringhad
beencorrected
to“work”
Work 176676
Noimpact
R2 - Nochangetokeyclinicalquestion
- Mentalhealth
conditions(vicarioustraumaremoved)
- Generalpracticeremoved
- Work-relatedness- Tools- Feb-April2017
Workinthe
compensable
setting
work 144 32
Ifwork-
relatedness
searchstringhad
beencorrected
to“work”
5937 Noimpact
EvidenceReviewGroupRecommendation:ForKeyclinicalquestion2thelargenumberof
hitsinOvidthatwouldhaveoccurredasaresultofthesearchstringerrorcorrectionwould
havemadethesearchunfeasible.Ourrecommendationistoacceptthefinal
recommendationasperGuidelineDevelopmentGroupmeeting3.
4.5 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:
Keyclinicalquestion2:
Thereviewaimedtoidentifyreliableandvalidworkplaceassessmenttoolsorinstruments
which may highlight workplace psychosocial factors with a probable association with
mental health conditions. Thirteen studies25284888-97
met the inclusion included.Quality
assessmentofthesestudiesispresentedinTable12.Thirteeninstrumentswhichassessed
work/jobpsychosocialcharacteriseswere identifiedandare listed intheevidenceprofile
table(Table13).Therewaslimitedreliabilityandvaliditydataforthesetoolsinthework-
relatedcontext.Notwithstandingthelimitations,theinstrumentsmayassistinestablishing
causality or attributionofmental health conditions towork in conjunctionwith through
history taking, including bearing in mind the possibility of malingering, and relevant
workplace incident reports. The instruments with the highest quality of evidence (Job
Content Questionnaire and Task Diagnosis Survey) pose feasibility difficulties in general
practicebecausecommercialuserequiresalicencingfee.Additionally,Table14showsan
evaluation of the instruments against the NHS R&D HTA criteria8 to aid in selecting
instrumentsforuseinclinicalpractice.
41
Table12.DownsandBlackChecklistqualityassessmentscoresforstudiesincludedinkeyclinical
question2
Reporting(Overallstudyquality)
Externalvalidity
Internalvalidity(Studybias)
Internalvalidity(Confoundingandselectionbias)
Powerofstudy
Total
Bennettetal.2005 7 3 3 2 0 15
Bond1994 7 3 3 4 0 17
Corneretal.1997 7 0 4 4 0 15
Gadingeretal.2012 10 3 3 4 0 20
Thorsen&Bjorner2010 9 3 3 3 1 19
Matuskoetal2013 7 0 3 1 0 11
Maffeo1990 6 0 3 1 0 10
Rauetal2010 10 2 4 4 0 20
Bégatetal2005 6 3 3 2 0 14
Williams&Cooper1998 8 2 4 2 0 16
Pejtersenetal2010 8 3 4 2 0 17
Mahmoodetal2010 8 3 4 2 0 17
Karaseketal1998 8 2 4 2 0 16
Mean 7.8(1.3) 2.1(1.3) 3.5 2.5 0.1 15.9
SD 1.3 1.3 0.5 1.1 0.3 3.0
42
Table13.GRADEEvidenceProfileTable:Inpatientswithadiagnosedmentalhealthcondition,whatmethodsareeffectiveatindicatingtheprobabilitythatthediagnosedmentalhealthconditionhasarisenasaresultofwork?
QualityAssessment Assessment
Instrument
Measured
attribute
No.of
studies
Study
Design
Riskof
Bias
Inconsi-
stency
Indirect-
ness
Imprec-
ision
Other
Considerations
No.of
partici-
pants
Relia-
bility
Valid-
ity
GRADE
Consultants’
MentalHealth
Questionnaire–
modifiedfor
usewithother
healthcare
professions
Jobstress 128 Cross-sectional
Notserious
Unclear none Unclear singlestudy 179 - - LOW
TheStressor
Scalefor
Paediatric
Oncology
Nurses(SSPON)
Work-relatedstressors
188 Cross-sectional
Notserious
Notserious
none notserious
singlestudy 250 0.93 - MOD
Work
environment
impactscale
(WEIS)
Workimpactonpeoplewithpsychiatricdisabilities(85%majordepression)
189 Cross-sectional
Notserious
Unclear none Unclear singlestudy,smallsample
20 - - LOW AuthorsconcludedthatWEIShasadequateinternalconsistencyandconstructvalidity
Work
environment
subscalesofthe
Work-Health-
Check(WHC)
Work-relatedpsychologicalstressors
190 Cross-sectional
Notserious
Notserious
none notserious
singlestudy 628 0.74-0.93
0.10-0.34
MOD Authorsconcludedgoodcriterionvaliditywhencorrelatedwithhealthindicators
Copenhagen
Psychosocial
QuestionnaireII
(COPSOQII)
Psychosocialimpactofworkenvironment
19192 Cross-sectional/Cohort
Notserious
Notserious
none notserious
3974 0.50-0.89
- MOD
43
TaskDiagnosis
Survey(TDS)Workcharacteristics(Jobdemandandjobcontrol)
125 Casecontrol
Notserious
unclear none unclear singlestudy 343 - - HIGH Significantassociationwithdepression
FIT
questionnaireWorkcharacteristics(Jobdemandandjobcontrol)
125 Casecontrol
Notserious
None none none singlestudy 343 0.7-0.8
0.74-0.77
HIGH Significantassociationwithdepression
Work
Environment
Questionnaire
(WEQ)
Nursingenvironmentstress/satisfaction
193 Crosssectional
serious None none none singlestudy 71 0.91 - MOD
Medicalreport
checklist
(historyof
illnessitems)
Processforestablishingcausallinkbetweeninjuryandwork
194 Crosssectional
serious unclear none unclear singlestudy 34 - - LOW oldpaperandunclearfromcurrentdocumentsifchecklistisstillinuse.
Clinician-
Administered
PTSDScale-
organisational
stressors
domain
Organisationalstressors
148 Crosssectional
serious unclear none unclear singlestudy 31 - - LOW
Pressure
Management
Indicator
(PMI)
Occupationalstress
195 Cohort Serious unclear none none singlestudy 14455 0.76 - MOD
Workplace
Stressors
Assessment
Questionnaire
Workplacestressors
196 Crosssectional
Notserious
Notserious
None serious Somepoorvalidity&lowprecisionforvalidity
2361 0.69–0.93
0.11-0.56
MOD Absolutecorrelations(criterionvalidity)withseveralinstruments
JobContent
Questionnaire
(JCQ)
psychosocialjobassessmentinstrument
197 Crosssectional
Notserious
Notserious
None None Criterionvaliditynotassessed
16601 0.73–0.74
- HIGH
44
Table14.InstrumentevaluationusingtheNHSR&DHTAcriteria
Tool Purpose/Assessedattribute Appropriateness
Reliability
Validity
Responsiveness
Precision
Interpretability
Acceptability
Feasibility
Comments
Consultants’MentalHealthQuestionnaire
Jobstress y unclear unclear unclear unclear easy y y Nomeasuresofresponsiveness,precision
TheStressorScaleforPaediatricOncologyNurses(SSPON)
work-relatedstressors y y unclear unclear unclear difficult fair fair Lengthy(50-items),complexscoring(0-5000)
Workenvironmentimpactscale(WEIS)
workimpactonpeoplewithpsychiatricdisabilities
y unclear unclear unclear unclear easy y y Noquantitativereliabilityvaliditydata.Authorsconcludedreliabilityandvaliditywereadequate.
WorkenvironmentsubscalesoftheWork-Health-Check(WHC)
Work-relatedpsychologicalstressors
y y poor unclear unclear easy y y Poorvalidity(0.10-0.34)althoughauthorsratedasgood.
CopenhagenPsychosocialQuestionnaireII(COPSOQII)
psychosocialimpactofworkenvironment
y y unclear unclear unclear easy y y
WorkEnvironmentQuestionnaire(WEQ)
psychologicalworkenvironment
y y y n/a n/a easy y y
TaskDiagnosisSurvey(TDS)
Workcharacteristics(Jobdemandandjobcontrol)
y y y n/a fair difficult n n Requirestrained/experiencedassessor;goodtoexcellentinterrater/test-retestreliability
Medicalreportchecklist(historyofillnessitems)
Processforestablishingcausallinkbetweeninjuryandwork
y n n n n difficult unclear n Unclearifchecklistisstillinusegrantedthepublishedpaperisold(1990)
Clinician-AdministeredPTSDScale-
Organisationalstressors y n/a n/a n/a n/a easy y y
45
Tool Purpose/Assessedattribute Appropriateness
Reliability
Validity
Responsiveness
Precision
Interpretability
Acceptability
Feasibility
Comments
organisationalstressorsdomainFITquestionnaire Workcharacteristics(Job
demandandjobcontrol)unclear y y n/a fair unclear unclear n Appearsthequestionnaireisin
GermanPressureManagementIndicator(PMI)
occupationalstress y unclear unclear n/a n/a easy fair fair Veryoldquestionnaire,notsureifrelevantintoday'scontext.
WorkplaceStressorsAssessmentQuestionnaire
Workplacestressors y y n/a n/a n/a easy fair fair
JobContentQuestionnaire(JCQ)
Psychosocialjobassessmentinstrument
y y unclear n/a y easy n y
46
5 Keyclinicalquestion3:Inworkers,whatfactorsassistintheearlydetectionofacomorbidwork-relatedmentalhealthcondition?
5.1 Evidencereviewroundone 5.1.1 PICO
PWorkers
IFlags
CFlagsthatindicateparticularmentalhealthconditions(e.g.PTSD,GAD,
depression)
OEarlydetection
5.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
1. ((Mentaladjhealth)or(Psychiatricadj(disorder*orillness*ordisease*orcondition*or
ailment*orepisode*))or(Mentaladj(disorder*orillness*ordisease*orcondition*or
ailment*orepisode*orsufferingorstress*ordistress))or(Psychologicaladj(disorder*
orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(Depressiveadj(disorder*orillness*ordisease*orcondition*orailment*
orepisode*orsuffering))or(Moodadj(disorder*orillness*ordisease*orcondition*
orailment*orepisode*orsufferingorstress*ordistress))or(Affectiveadj(disorder*
orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(Adjustmentadj(disorder*orillness*ordisease*orcondition*orailment*
orepisode*orsufferingorstress*ordistress))or(Posttraumaticadj(disorder*or
illness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(AnxietyorstressorDepressionorVicarioustrauma)).mp.[mp=ab,hw,ti,
tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
2. (((Measure*orMeasurement*orOutcome*orAssessment*orEvaluat*orTest*or
Questionnaire*orScale*or(Mentaladjstatus)or(Psychiatr*adjrating*)or(Patientadj
acuity)orSeverityofIllness*or(IllnessadjSeverity)or(Healthadjstatus)orSickness
impactprofile*orIndicator*orInvestigat**orExamin*orInstrument*or
Questionnaire*orScreen*orQualityoflifeorDiagnos*orDiagnostic*orDiagnostic)
adj(tool*ortechnique*orprocedure*))ortool*or(Personalityadjscale*)or
(personalityadjinventory)orPsychometr*orSensitiv*orResponsivenessorValid*or
Reliab*orAccura*orindexorindicesorprotocol*orscore*orscoring*orguideline*or
(Clinicaladjdecision*)orSurveillanceor(timelyadjdiagnosis)orspecific*or
precis*).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
3. ((((Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*
oremploymentorjobortradeor((joborworkoremploymentortrade)adjrelated)or
47
occupational)adj(disease*orillness*orhealth))orCompensation)adj(claim*or
compensation)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,
tm]
4. ((earlyadjdetection)or(earlyadjdiagnosis)ordetect*).mp.[mp=ab,hw,ti,tn,ot,dm,
mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
5. 2or4
6. 1and3and5
5.1.3 SearchStrategy:CINAHL
# Query Limiters/Expanders
S1
“Mentalhealth”or(PsychiatricAND(healthordisorder*or
illness*ordisease*orcondition*orailment*orepisode*))or
(MentalAND(healthordisorder*orillness*ordisease*or
condition*orailment*orepisode*orsufferingorstress*or
distress))or(PsychologicalAND(disorder*orillness*or
disease*orcondition*orailment*orepisode*orsufferingor
stress*ordistress))or(DepressiveAND(disorder*orillness*or
disease*orcondition*orailment*orepisode*orsuffering))or
(MoodAND(disorder*orillness*ordisease*orcondition*or
ailment*orepisode*orsufferingorstress*ordistress))or
(AffectiveAND(disorder*orillness*ordisease*orcondition*
orailment*orepisode*orsufferingorstress*ordistress))or
(AdjustmentAND(disorder*orillness*ordisease*or
condition*orailment*orepisode*orsufferingorstress*or
distress))or((“Posttraumatic”ORtraumatic)AND(disorder*or
illness*ordisease*orcondition*orailment*orepisode*or
sufferingorstress*ordistress))orAnxietyorstressor
Depressionor“Vicarioustrauma”
Searchmodes-Boolean/
Phrase
S2
Measure*orMeasurement*orOutcome*orAssessment*or
Evaluat*orTest*orQuestionnaire*orScale*or(Mentalstatus)
or(Psychiatr*rating*)or(Patientacuity)orSeverityofIllness*
or(IllnessadjSeverity)or(Healthstatus)or(Sicknessimpact
profile*)orIndicator*orInvestigat**orExamin*or
Instrument*orQuestionnaire*orScreen*or(Qualityoflife)or
Diagnos*orDiagnostic*or((Diagnosticand(tool*or
technique*orprocedure*))ortool*or(Personalityscale*)or
(personalityinventory)orPsychometr*orSensitiv*or
ResponsivenessorValid*orReliab*orAccura*orindexor
indicesorprotocol*orscore*orscoring*orguideline*or
(Clinicaldecision*)orSurveillanceor(timelydiagnosis)or
specific*orprecis*
Searchmodes-Boolean/
Phrase
48
S14
HADSor“MOSMentalHealthInventory”or“Depression
Screener”or“BeckDepressionInventory”or“PatientHealth
Questionnaire”orPHQor“PrimaryCareEvaluationofMental
Disorders”or“PRIME-MD”or“BRFSSAnxiety&Depression
OptionalModule”or“BRFSSMentalIllness&StigmaOptional
Module”orMADRSorMADRS-Sor“MontgomeryAsberg
DepressionRatingScale”or“NHISNon-SpecificDistress
Battery”or“AreasofWorklifeScale”orAWSor“Perceived
StressScale”or“PSS”or“PositiveandNegativeAffectTest”or
“PsychologicalWell-BeingScale”or“PrimaryCarePTSDScreen”
or“PC-PTSD”
Searchmodes-Boolean/
Phrase
S15 (earlydetection)or(earlydiagnosis)ordetect*Searchmodes-Boolean/
Phrase
S16 sensitivityorspecificityorprecisionoraccuracyorreliabilitySearchmodes-Boolean/
Phrase
S17 S2ORS14Searchmodes-Boolean/
Phrase
S18 S16ANDS17Searchmodes-Boolean/
Phrase
S19 S1ANDS18Searchmodes-Boolean/
Phrase
S20 S1ANDS18
Limiters-EnglishLanguage;
AgeGroups:Adolescence,13-
18years,Adult,19-44years,
MiddleAge,45-64years,
Aged,65+years,Aged,80
andover
Searchmodes-Boolean/
Phrase
S21 S4ANDS20Searchmodes-Boolean/
Phrase
S22 S1ANDS2ANDS4ANDS15Searchmodes-Boolean/
Phrase
5.1.4 Searchperiod
Databaseinceptiontothe31stofJanuary2017.
5.1.5 PRISMAround1
Embase,Medline,PsycINFOandAMEDreturnedn=67recordsandCINAHLreturnedn=589
records.
49
Figure9.RoundonePRISMAchartforkeyclinicalquestions3
5.2 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting
- ReviseKeyclinicalquestion3toread:Inworkers,whatfactorsassistintheearlydetectionofacomorbid*work-relatedmentalhealthcondition?
- Expandsearchstrategytolookguidelinesandsystematicreviewslookingatmentalhealthconditionsgenerally(notjustwork-related)forfactorsassistinginearlydetection.
5.3 Evidencereviewroundtwo
5.3.1 PICO
PWorkers
ISignsandsymptomsofamentalhealthconditionthatarenotaresultofa
comorbidcondition
CSignsandsymptomsforamentalhealthconditionthatarearesultofa
comorbidcondition
50
OEarlydetection
5.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
1. ((Mentaladjhealth)or(Psychiatricadj(disorder*orillness*ordisease*orcondition*or
ailment*orepisode*))or(Mentaladj(disorder*orillness*ordisease*orcondition*or
ailment*orepisode*orsufferingorstress*ordistress))or(Psychologicaladj(disorder*
orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(Depressiveadj(disorder*orillness*ordisease*orcondition*orailment*
orepisode*orsuffering))or(Moodadj(disorder*orillness*ordisease*orcondition*
orailment*orepisode*orsufferingorstress*ordistress))or(Affectiveadj(disorder*
orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(Adjustmentadj(disorder*orillness*ordisease*orcondition*orailment*
orepisode*orsufferingorstress*ordistress))or(Posttraumaticadj(disorder*or
illness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*or
distress))or(AnxietyorstressorDepression)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,
fx,nm,kf,px,rx,ui,sy,tc,id,tm]
2. ((((Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*or
employmentorjobortradeor((joborworkoremploymentortrade)adjrelated)or
occupational)adj(disease*orillness*orhealth))orCompensation)adj(claim*or
compensation)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,
tm]
3. ((earlyadjdetection)or(earlyadjdiagnosis)ordetect*or(timelyadjdiagnosis)).mp.
[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
4. 1and2and3
5.3.3 SearchStrategy:CINAHL
# Query Limiters/Expanders
S1
“Mentalhealth”or(PsychiatricAND(healthordisorder*or
illness*ordisease*orcondition*orailment*orepisode*))or
(MentalAND(healthordisorder*orillness*ordisease*or
condition*orailment*orepisode*orsufferingorstress*or
distress))or(PsychologicalAND(disorder*orillness*or
disease*orcondition*orailment*orepisode*orsufferingor
stress*ordistress))or(DepressiveAND(disorder*orillness*or
disease*orcondition*orailment*orepisode*orsuffering))or
(MoodAND(disorder*orillness*ordisease*orcondition*or
ailment*orepisode*orsufferingorstress*ordistress))or
(AffectiveAND(disorder*orillness*ordisease*orcondition*
orailment*orepisode*orsufferingorstress*ordistress))or
(AdjustmentAND(disorder*orillness*ordisease*or
Searchmodes-Boolean/
Phrase
51
condition*orailment*orepisode*orsufferingorstress*or
distress))or((“Posttraumatic”ORtraumatic)AND(disorder*or
illness*ordisease*orcondition*orailment*orepisode*or
sufferingorstress*ordistress))orAnxietyorstressor
Depressionor“Vicarioustrauma”
S4
Worker*orstafforemployee*orworkplace*orvocation*or
workoroccupation*oremploymentorjobortradeor“job
related”or“workrelated”or“employmentrelated”or“trade
related”or“occupationaldisease*”or“occupationalillness*”
or“occupationalhealth”orCompensationorclaim*
Searchmodes-Boolean/
Phrase
S15(earlydetection)or(earlydiagnosis)ordetect*or(timely
diagnosis)
Searchmodes-Boolean/
Phrase
S20 S1ANDS15
Limiters-EnglishLanguage;
AgeGroups:Adolescence,
13-18years,Adult,19-44
years,MiddleAge,45-64
years,Aged,65+years,
Aged,80andover
Searchmodes-Boolean/
Phrase
S21 S4ANDS20Searchmodes-Boolean/
Phrase
5.3.4 Searchperiod
Fromthe1stofFebruary2017tothe30thofApril2017.
5.3.5 PRISMAroundtwo
Embase,Medline,PsycINFOandAMEDreturnedn=150recordsandCINAHLreturnedn=18
records.
52
Figure10.RoundtwoPRISMAchartofkeyclinicalquestion3updates
53
Figure11.CombinedroundoneandroundtwoPRISMAchartforkeyclinicalquestion3
5.4 ExistingGuidelinesandSystematicReviewsforKeyclinicalquestion3
5.4.1 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting
- Revisekeyclinicalquestion3toread:Inworkers,whatfactorsassistintheearlydetectionofacomorbid*work-relatedmentalhealthcondition?
- Expandsearchstrategytolookguidelinesandsystematicreviewslookingatmentalhealthconditionsgenerally(notjustwork-related)forfactorsassistinginearlydetection.
5.4.2 PICO
PWorkers
ISignsandsymptomsofamentalhealthconditionthatarenotaresultofa
comorbidcondition
CSignsandsymptomsforamentalhealthconditionthatarearesultofa
comorbidcondition
OEarlydetection
54
5.4.3 Guidelines
Table15.Searchstrategyforexistingguidelinesforkeyclinicalquestion3
GuidelineResource SearchstrategyandLimitersGINMentalDisorders(Meshterms),English,
NationalGuidelineClearinghouse/physical
medicineandrehabilitation
Listreview
NationalGuidelineClearinghouse/psychiatric Listreview
NationalGuidelineClearinghousepsychology Listreview
NationalGuidelineClearinghouse workANDPTSDANDreview
returntowork
workANDdepressionANDreview
NHMRCClinicalGuidelinesPortal Listreview
RACGP Listreview
RANZCP Listreview
NICE/Mentalhealthandbehaviouralconditions ListReview
NICE/Injuries,accidentsandwounds ListReview
SIGN Listreview
SIGN Mentalhealth(keyword)
WHO Listreview
Pubmed workANDmentalhealthANDguideline
(Review)
Google workANDadjustmentdisordersANDguideline
work-relatedANDmentalillnessANDguideline
5.4.3.1 Searchperiod
Uptothe25thofMay2017.
55
5.4.3.2 PRISMA-Guidelines
Figure12.PRISMAchartofguidelinesforkeyclinicalquestion3
Table16.Guidelineswithrecommendationsaddressingkeyclinicalquestion3
GuidelineTitle GuidelineAuthor Date AGREEscore
Depression:Thetreatmentandmanagementof
depressioninadults13NICE 2016 92%
Depressioninadultswithachronicphysical
healthproblem:recognitionandmanagement12NICE 2015 100%
DiagnosisandTreatmentofPost-traumaticStress
DisorderinEmergencyServiceWorkers98BlackDogInstitute,The
UniversityofNewSouth
Wales
2015 73%
Clinicalpracticeguidelinesforthemanagement
ofrotatorcuffsyndromeintheworkplace99Hopmanetal.,The
UniversityofNewSouth
Wales
2013 83%
Recommendationsonscreeningfordepressionin
adults69CanadianTaskForceon
PreventiveHealthCare2013 75%
56
GuidelineTitle GuidelineAuthor Date AGREEscore
Alcohol-usedisorders:diagnosis,assessmentand
managementofharmfuldrinkingandalcohol
dependence[CG115]15
NICE 2011 83%
Generalisedanxietydisorderandpanicdisorder
inadults[CG113]16NICE 2011 83%
5.4.4 Systematicreviews
Table17.Searchstrategyforexistingsystematicreviewsforkeyclinicalquestion1
SystematicReviewResource SearchStrategyandLimitersCampbellCollaborationLibrary Listreview
CampbellCollaborationLibrary Work(keywordsearch)
CochraneLibrary [[Mentalorpsychologicalorpsychiatricor
stressordistressordepressormoodor
affectiveoradjustmentortraumaticoranxiety]
AND["earlydetection"or"earlydetect"or
"earlydiagnosis"]AND[comorbid]]RESTRICTby
Cochranereviews
CochraneLibrary Comorbid(Meshterm)
CochraneReviews/topicmentalhealth Listreview
CochraneReviews/topichealthandsafetyat
work
Listreview
CochraneReviews/“Work”reviewgroup Listreview
CochraneReviews/”Injuries”reviewgroup Listreview
CochraneReviews/”Drugsandalcohol”review
group
Listreview
CochraneReviews/Commonmentaldisorders
reviewgroup
Listreview
JoannaBriggsInstitute Mentalhealthlistreview
JoannaBriggsInstitute Depression(keyword)
5.4.4.1 Searchperiod
Uptothe10thofMay2017.
5.4.4.2 PRISMA-Systematicreviews
57
Figure13.PRISMAchartofsystematicreviewsforkeyclinicalquestion3
5.5 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion3
Table18.Keyclinicalquestion3literaturesearchresultsandimplicationsarisingfromsearchstrings
usedinrelationtowork
EvidenceReviewRounds
Originalkeyclinicalquestion3.Inworkers,whatfactorsassistinthe
earlydetectionofa
work-relatedmental
healthcondition?
Ovidimplication CINAHLimplication
OVIDcount CINAHLcount
R1 - Mentalhealth
conditions(included
vicarioustrauma)
- Work-relatedness
- Earlydetection
factors
- Measures
Workinthe
compensable
setting
work 67 589
Ifwork-
relatedness
searchstringhad
beencorrected
to“work”
Work 184073
Noimpact
R2 RevisedKeyclinicalquestion3.Inworkers,whatfactorsassistinthe
earlydetectionofa
Workinthe
compensable
setting
work 150 18
58
EvidenceReviewRounds
Originalkeyclinicalquestion3.Inworkers,whatfactorsassistinthe
earlydetectionofa
work-relatedmental
healthcondition?
Ovidimplication CINAHLimplication
OVIDcount CINAHLcount
comorbidwork-related
mentalhealth
condition?
- Mentalhealth
conditions(vicarioustraumaremoved)
- Work-relatedness- Earlydetection
factors
- Feb-April2017
Ifwork-
relatedness
searchstringhad
beencorrected
to“work”
Work 615 Noimpact
Searchfor
guidelines
and
systematic
reviews
Guidelinesn=52
Systematicreviewsn=6
EvidenceReviewGroupRecommendation:Forkeyclinicalquestion3thereviewshouldconsiderthe615hitsinOvidthatwouldhaveoccurredasaresultofthesearchstringerror
correctioninround2inordertoinformthefinalguidelinerecommendationofthe
GuidelineDevelopmentGroup.
Followingtheaboverecommendation,anupdatedsearchwasperformedforkeyclinical
question3andnonewstudieswereidentifiedasshowninFigure14.
59
Figure14.Searchoutcomeforkeyclinicalquestion3followingevidencereviewrecommendations
5.6 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:Keyclinicalquestion3
Four studies 30 100-102 met the inclusion criteria for this key clinical question and quality
assessmentofthesestudiesarepresentedinTable19.Thereviewidentifiedseveralfactorswhichwereassociatedwithmentalhealthsymptoms, thuscouldbedeemedpredisposing
factorsforamentalhealthcondition.Thesewerework/job-relatedfactors,physicalinjury,
intrinsicpatientpersonalityandpsychosocial factors (Table20). Theoverallqualityof the
evidenceforthesepotentialriskfactorswaslow.
60
Table19.DownsandBlackChecklistqualityassessmentscoresforstudiesincludedinkeyclinical
question3
Reporting(Overallstudyquality)(10)
Externalvalidity(3)
Internalvalidity(Studybias)(8)
Internalvalidity(Confoundingandselectionbias)(6)
Powerofstudy(1)
Total(28)
Andersonetal2016
9.5 2 4 4 0 19.5
Ioannouetal2016 8.5 2 4 3 0 17.5
Pjanicetal2014 5 3 2 3 1 14
LaMontagneetal2008
4 3 2 2 1 12
Mean 6.75 2.5 3 3 0.5 15.8
SD 2.7 0.6 1.2 0.8 0.6 3.4
61
Table20.GRADEEvidenceProfileTable:Inworkers,whatfactorsassistintheearlydetectionofacomorbidwork-relatedmentalhealthcondition?
MHC QualityAssessment(GRADECriteria) Effect GRADENo.ofstudies
StudyDesign RiskofBiasi
Inconsistencyii Indirectness Imprecision OtherConsiderations
No.ofparticipants
Absolute Relative
Depression;anxiety;adjustmentdisorder
430100-102 Casecontrol;crosssections;cohort
Serious Serious Notserious None Lowtomoderatequalitystudies
2216 - - LOW
Outcome:EarlydetectionofMHCFactorswhichwereassociatedwithorcontributedtoMHCsymptomsincluded;
• Jobstrain• failuretoRTWfollowinginjury• Greaterpainintensity,wherephysicalinjurywastheprecursortoMHC• Lowerself-efficacy• Lacksocialsupportandpersonalrelationshipstatus,i.e.relationshipproblems• Perceptionofinjusticeofthecompensationclaimprocess
62
6 Keyclinicalquestion4:Inpatientswithwork-relatedstress,whatGPstrategiesresultinthehighestlevelsofpersonalrecoveryand/orreturntowork?
6.1 Evidencereviewroundone 6.1.1 PICO
PPatientswithwork-relatedstressIManagementoptionsCAllmanagementoptionsOPersonalrecovery;Returntowork
6.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
1. ((Mentaladjhealth)or(Psychiatricadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*))or(Mentaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Psychologicaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Depressiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(Moodadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Affectiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Adjustmentadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Posttraumaticadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AnxietyorstressorDepressionorVicarioustrauma)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
2. ((Generaladj(practi*orphysician*ordoctor))or(Familyadj(practi*orphysician*ordoctor*))or(Familyadjmedic*adj(practi*ordoctor*))or(Primaryadjcareadj(practi*orphysician*ordoctor*))or(((Occupationalhealthadj(practi*orphysician*ordoctor*orspecialist*))orcompany)adjphysician*)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
3. ((((Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor((joborworkoremploymentortrade)adjrelated)oroccupational)adj(disease*orillness*orhealth))orCompensation)adj(claim*orcompensation)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
63
4. (Strateg*orIntervention*orTreatment*orCare*ormanag*orapproach*ordecision*oraction*orTherap*orrefer*).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
5. (ReturntoworkorRecov*orImprov*orResolution*orresolv*orRespon*oroutcome*or(treatmentadjoutcome*)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
6. 1and2and3and4and5
6.1.3 SearchStrategy:CINAHL
# Query Limiters/Expanders
S1
“Mentalhealth”or(PsychiatricAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*))or(MentalAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(PsychologicalAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(DepressiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(MoodAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AffectiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AdjustmentAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or((“Posttraumatic”ORtraumatic)AND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))orAnxietyorstressorDepressionor“Vicarioustrauma”
Searchmodes-Boolean/Phrase
S3
(GeneralAND(practi*orphysician*ordoctor))or(FamilyAND(practi*orphysician*ordoctor*))or(Familymedic*(practi*ordoctor*))or(“Primarycare”AND(practi*orphysician*ordoctor*))or(“Occupationalhealth”AND(practi*orphysician*ordoctor*orspecialist*))or“companyphysician*”
Searchmodes-Boolean/Phrase
S4
Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor“jobrelated”or“workrelated”or“employmentrelated”or“traderelated”or“occupationaldisease*”or“occupationalillness*”or“occupationalhealth”orCompensationorclaim*
Searchmodes-Boolean/Phrase
S5Strateg*orIntervention*orTreatment*orCare*ormanag*orapproach*ordecision*oraction*orTherap*orrefer*
Searchmodes-Boolean/Phrase
S6"Returntowork"orRecov*orImprov*orResol*orresolv*orRespon*oroutcome*or"treatmentoutcome*"
Searchmodes-Boolean/Phrase
64
S13
"Returntowork"OREvaluation*ORDecision*ORPrognosisORIndicat*ORGuide*ORmarker*ORAbsenteeismOR"Sick*leave"OR"Sicknesscertificat*"OR"WorkScheduleTolerance*"OR"Workperformance*"OR"Workabilit*”OR“workcapacit*”OR“workdisabilit*”OR“workread*”OR“Modifiedwork”OR“modifieddut*”OR“Workread*”
Searchmodes-Boolean/Phrase
S23 S1ANDS4ANDS5ANDS6ANDS13Searchmodes-Boolean/Phrase
S24 S3ANDS23Searchmodes-Boolean/Phrase
6.1.4 Searchperiod
Databaseinceptiontothe31stofJanuary2017.6.1.5 PRISMAroundone
Embase,Medline,PsycINFOandAMEDreturnedn=4recordsandCINAHLreturnedn=1614records.
65
Figure15.RoundonePRISMAchartforkeyclinicalquestion4
6.2 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting
- Includethe30studiesthatwereoriginallyexcluded(24)fromfulltextreviewduetonotfocusingonwork-relatednessand(6)duetothesamplenotbeingGPs.
- Revisethekeyclinicalquestiontoread:“inpatientswithamentalhealthcondition,whatGPstrategiesresultinthehighestlevelofpersonalrecoveryand/orreturntowork?”
6.3 Evidencereviewroundtwo
6.3.1 PICO
PPatientswithmentalhealthconditionsIHealthprofessionalstrategiesCAllhealthprofessionalstrategiesOPersonalrecoveryand/orreturntowork
66
6.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
1. ((Mentaladjhealth)or(Psychiatricadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*))or(Mentaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Psychologicaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Depressiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(Moodadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Affectiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Adjustmentadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Posttraumaticadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AnxietyorstressorDepression)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
2. ((Generaladj(practi*orphysician*ordoctor))or(Familyadj(practi*orphysician*ordoctor*))or(Familyadjmedic*adj(practi*ordoctor*))or(Primaryadjcareadj(practi*orphysician*ordoctor*))or(((Occupationalhealthadj(practi*orphysician*ordoctor*orspecialist*))orcompany)adjphysician*)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
3. ((((Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor((joborworkoremploymentortrade)adjrelated)oroccupational)adj(disease*orillness*orhealth))orCompensation)adj(claim*orcompensation)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
4. (Strateg*orIntervention*orTreatment*orCare*ormanag*orapproach*ordecision*oraction*orTherap*orrefer*).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
5. (ReturntoworkorRecov*orImprov*orResolution*orresolv*orRespon*oroutcome*or(treatmentadjoutcome*)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
6. 1and2and3and4and5
6.3.3 SearchStrategy:CINAHL
# Query Limiters/Expanders
S1“Mentalhealth”or(PsychiatricAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*))or
Searchmodes-Boolean/Phrase
67
(MentalAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(PsychologicalAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(DepressiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(MoodAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AffectiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AdjustmentAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or((“Posttraumatic”ORtraumatic)AND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))orAnxietyorstressorDepression
S3
(GeneralAND(practi*orphysician*ordoctor))or(FamilyAND(practi*orphysician*ordoctor*))or(Familymedic*(practi*ordoctor*))or(“Primarycare”AND(practi*orphysician*ordoctor*))or(“Occupationalhealth”AND(practi*orphysician*ordoctor*orspecialist*))or“companyphysician*”
Searchmodes-Boolean/Phrase
S4
Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor“jobrelated”or“workrelated”or“employmentrelated”or“traderelated”or“occupationaldisease*”or“occupationalillness*”or“occupationalhealth”orCompensationorclaim*
Searchmodes-Boolean/Phrase
S5Strateg*orIntervention*orTreatment*orCare*ormanag*orapproach*ordecision*oraction*orTherap*orrefer*
Searchmodes-Boolean/Phrase
S6"Returntowork"orRecov*orImprov*orResol*orresolv*orRespon*oroutcome*or"treatmentoutcome*"
Searchmodes-Boolean/Phrase
S13
"Returntowork"OREvaluation*ORDecision*ORPrognosisORIndicat*ORGuide*ORmarker*ORAbsenteeismOR"Sick*leave"OR"Sicknesscertificat*"OR"WorkScheduleTolerance*"OR"Workperformance*"OR"Workabilit*”OR“workcapacit*”OR“workdisabilit*”OR“workread*”OR“Modifiedwork”OR“modifieddut*”OR“Workread*”
Searchmodes-Boolean/Phrase
S23 S1ANDS4ANDS5ANDS6ANDS13Searchmodes-Boolean/Phrase
S24 S3ANDS23Searchmodes-Boolean/Phrase
6.3.4 Searchperiod
Fromthe1stofFebruary2017toApril2017
68
6.3.5 PRISMAroundtwo
Embase,Medline,PsycINFOandAMEDreturnedn=6recordsandCINAHLreturnedn=38records.
Figure16.RoundtwoPRISMAchartofkeyclinicalquestion4updates
69
6.3.6 Figure17.CombinedroundoneandroundtwoPRISMAchartforkeyclinicalquestion4
6.4 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion4
Table21.Keyclinicalquestion4literaturesearchresultsandimplicationsarisingfromsearchstringsusedinrelationtowork
EvidenceReviewRounds
Originalkeyclinicalquestion4.Inpatientswithwork-relatedstress,whatGPstrategiesresultinthehighestlevelsofpersonalrecoveryand/orreturntowork?
Ovidimplication CINAHLimplication
OVIDcount CINAHLcount
R1 - Mentalhealthconditions(includedvicarioustrauma)
- Generalpractice- Work-relatedness- Strategies- Returntoworkand
recovery
Workinthecompensablesetting
work 4 1614
Ifwork-relatednesssearchstringhadbeencorrectedto“work”
Work 4725 Noimpact
70
R2 RevisedKeyclinicalquestion4.Inpatientswithamentalhealthcondition,whatGPstrategiesresultinthehighestlevelofpersonalrecoveryand/orreturntowork?- Mentalhealth
conditions(vicarioustraumaremoved)
- Generalpractice- Work-relatedness- Strategies- Returntoworkand
recovery- Feb–April2017
Workinthecompensablesetting
work 6
38
Ifwork-relatednesssearchstringhadbeencorrectedto“work”
Work 126 Noimpact
EvidenceReviewGroupRecommendation:Forkeyclinicalquestion4thereviewshouldconsiderthe126hitsinOvidthatwouldhaveoccurredasaresultofthesearchstringerrorcorrectioninround2inordertoinformthefinalguidelinerecommendationoftheGuidelineDevelopmentGroup.
Followingtheaboverecommendation,anupdatedsearchwasperformedforkeyclinicalquestion4andtwonewstudieswereidentifiedforinclusionasshowninFigure18.
71
Figure18.Searchoutcomeforkeyclinicalquestion4followingevidencereviewrecommendations
6.5 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:
Keyclinicalquestion4 Sixteen studies 103-118 of varying design comparing test interventions to usual care wereincludedforthiskeyclinicalquestion.Twopapers113119werepublicationsofthesamestudy,withone reporting interim results 119while theother reported the final results 113. The16studiesandtheirmethodologicalqualityarepresentedinTable22.Whiletherewasatrendtowardsgreaterreturntoworkorpersonalrecoveryinfavourofinterventions,theeffectswere highly varied and not significant, with highly variable effect. Onemoderate qualityobservational study 112 showed a collaborative care intervention (vs. usual care) maysignificantly lead to symptoms remission at six months and one low quality study 107suggestedmultidisciplinarycare(vs.GPusualcare)mayincreaseratesofreturntoworkatthreemonths.Inrelationtoe-health,theoverarchingprincipleisintheopportunityforanalternative means of service provision rather than the content specifics. The overallevidencefromprimarystudiesissummarisedinTable23.Additionally, existing systematic reviews identified through database searches or othersourceswereconsideredinkeyclinicalquestion4.Thereviewsthatcoveredthescopefor
72
thiskeyclinicalquestionandwereusedto informtherecommendationare listedinTable24,togetherwiththeirAMSTARqualityscores.Interventions:socialworkledprogramvs.GPusualcare;Multidisciplinarycareprogramvs.GPusualcare;Occupationalphysicianstrainedinguideline-basedcare;E-healthmoduleforoccupationalphysiciansOutcomes:Returntowork(Ratesofresumptionoffull/partialreturntowork;Absenteeism)andPersonalrecovery(Remission,changeinsymptomscores,CHIME)
Table22.DownsandBlackChecklistqualityassessmentscoresforstudiesincludedinkeyclinicalquestion4
Reporting(Overallstudyquality)
Externalvalidity
Internalvalidity(Studybias)
Internalvalidity(Confoundingandselectionbias)
Powerofstudy
Total
Benderetal2016103
8 1 6 2 0 26
Brouwersetal2006104
9 3 5.5 5.5 0 22.5
Kingetal2014105 8 2.5 4.5 5 0 20.5
Kivietal2014106 8.5 2.5 4 6 0.5 22Netterstrømetal2013107
7 1 4 3 0 15
Nieuwenhuijsenetal2003108
8.5 2 4 3.5 0 18.5
Prangetal2016109
9 1 5 3.5 0 18.5
Rebergenetal2009110
8 1 6 5.5 0 19.5
Rostetal2004111 8.5 1 4.5 4.5 0 18.5
Shippeeetal2013112
9 2.5 4 3.5 0 19.5
Vlasveldetal2012119and2013113
9 2 5.5 6 0 22.5
Volkeretal2015114
10 3 6 6 1 26
vanderKlinketal2003115
11 2 7 6 0 26
FletenandJohnsenetal2006116
11 3 4 5 0 23
NystuenandHagen2006117
9 2 6 6 0 23
Holstetal2017118 6.5 1.5 3 4 0 15Mean 8.8 1.9 4.9 4.7 0.1 21.4
SD 1.2 0.8 1.1 1.3 0.3 3.2
73
Table23.GRADEEvidenceProfileTable:Inpatientswithamentalhealthcondition,whatGPstrategiesresultinthehighestlevelsofpersonalrecoveryandreturntowork?
QualityAssessment(GRADECriteria) No.ofparticipants Effect
GRADE CommentsMHC
No.ofstudies
StudyDesign
RiskofBias
Inconsistency
Indirectness
Imprecision
OtherConsiderations
Intervention(n)
Control(n)
Absolute
Relative
ReturntoWorkAnxietyanddepression
1104 RCT Notserious
None Notserious
Notserious
Singlestudy,Dutchcontext
86 77 5.0%(5,16)
- MOD
Intervention:Socialworkerledprogram(“activatingandsupportingthepatienttorestorecopingandtoadoptaproblem-solvingapproachtowardhis/herproblems”)vs.GPusualcareOutcome:Returntowork–interventionvs.controlpartialorfulltimereturntoworkrates-nosignificantdifference
Stress,Depression
2107113 RCT Notserious
None Serious Serious Contextapplicability(Dutch&Danishsettings)
125 120 6%to31%
- MOD
Interventions:Multidisciplinary/Collaborativecare-teamscomprisingspecialistinoccupationmedicine,psychologists,caremanagevsGPusualcareOutcome:Returntowork–Fulltimereturntoworkrates,interventionvs.control.Onelowqualitystudywithsignificantlyhigherreturntoworkrateat3months.Nodifferencefromsecond,high-qualitystudyat12monthsfollow-up
PTSD 1103 Quasi-RCT
Serious
Notserious none serious Singlenon-RCTormodquality
68 58 -13%(2,-26)
- LOW Nodifferencebetweenmultidisciplinaryprogramvs.GPusualcare
Intervention:Multidisciplinaryassessmentandtreatmentprogramcomprisingreturntoworkcoordination,education,andreferraltospecialisedmentalhealthvs.GPusualcareOutcome:Returntowork–Fullreturntoworkrateshigherbutnotsignificantforcontrolatsixmonths
Anxietyplusdepression
1110 RCT Serious
None Serious Serious Contextapplicability(Dutchpoliceofficers); lowqualitystudy
125 115 15%(3,27)
- LOW
74
QualityAssessment(GRADECriteria) No.ofparticipants Effect
GRADE CommentsMHC
No.ofstudies
StudyDesign
RiskofBias
Inconsistency
Indirectness
Imprecision
OtherConsiderations
Intervention(n)
Control(n)
Absolute
Relative
Intervention:Caredeliveredbyoccupationalphysicians(OP)trainedinguidelinebasedcarevsOPusualcareOutcome:Returntowork–significantlygreaterfull-timereturntoworkratesat12months,infavourofintervention
depression,anxiety,andsomatizationdisorders
1114 RCT Notserious
none Notserious
none Dutchstudy 74 57 6.2(-10,22.3)
- MOD
Intervention:“E-healthmoduleembeddedincollaborativeoccupationalhealthcare”aimedat‘sicklistedemployees’cognitionsregardingreturntoworkwithphysicalorpsychologicalsymptomsandoptionstoresumeworkatleastonapartialbasiswhilesymptomsarestillpresent,plusemaildecisionaidfortreatingoccupationalphysiciansvs.OPusualcareOutcome:Returntowork(Full-timereturntoworkrates)–greaterbutnon-significantreturntoworkratefortheintervention
Adjustmentdisorders
1115 RCT None None Notserious
Serious Contextapplicability(Dutch)
109 83 -11.7(-21.0,-3.9)
- HIGH 3monthsRTWrates
Intervention:Trainedoccupationalphysiciandeliveredactivatingintervention:gradedactivityoverthreestages,1)informationonunderstandingtheoriginandcauseofthelossofcontrolanddoinglessdemandingtasks;2)drawupaninventoryofstressorsandtodevelopproblemsolvingstrategiesforthesecausesofstress,and;3)puttheseproblem-solvingstrategiesintopracticeandextendtheiractivitiestoincludemoredemandingones.Emphasisonactiveroleinrecoveryprocess.UsualcarecontrolOutcome:Partialorfullreturntowork-significantlygreaterreturntoworkratesinfavourfortheinterventionatthreemonths;nodifferenceat12months[0(-4.4,3.4)].
Depression&otherMHdisorders
1116 RCT Notserious
None Serious Notserious
Contextapplicability(Norwegianstudy,unclear whatother MHCswere)
79 90 - 1.36(0.98to1.89)
MOD Hazardratio,MHsubgroup(comparedtocontrol)
Intervention:Minimalinterventiondeliveredviapostpackage:informationaboutreturntoworkonmodifiedduties,andquestionnairewiththemesaroundcapacitytoreturntoworkonmodifiedduties,vscontrol(nodetails)Outcome:Returntowork(lengthofsickleave)–nodifferencebetweeninterventionandcontrolat12monthsfollow-up
75
QualityAssessment(GRADECriteria) No.ofparticipants Effect
GRADE CommentsMHC
No.ofstudies
StudyDesign
RiskofBias
Inconsistency
Indirectness
Imprecision
OtherConsiderations
Intervention(n)
Control(n)
Absolute
Relative
Psychologicaldistressorburnout
1117 RCT Notserious
Noserious Serious Serious Noquantitativedata;IncludesburnoutNorwegiancontext
25 15 Reportednodifference
LOW Includesburnout
Intervention:Individualorgroupsolutionfocussedpractice;eightweeklysessionsoffourhoursoncopingstrategies,supportbetweentheparticipantsandsolutionsandgoalsforthefuture.Halfthetimewasspentinaplenarysessionwhereatopicofthedaywasintroducedanddiscussed.Thesetopicswere:1)introduction;2)Self-esteem;3)Qualitysick-leave;4)Communication;5)Conflicthandling;6)Difficultchoices;7)Copingwithstress,and;8)Follow-upControl=Usualcare.Outcome:Returntowork(lengthofsickleave)–nodatabutreportedlynodifference(nodata)at12months
Stress;PTSD/Anxiety;Adjustmentdisorder;other
2108109 Cohort
Serious
Serious Notserious
None Moderatequalitycohortstudies
8458 - 0.3to0.83
MOD Hazardratiossuggestlongertimetoreturntowork
Non-interventionalstudies:1)Retrospectivedataaudittoassessqualityofoccupationalrehabservicesforadjustmentdisordersand2)modellingthatevaluatedfactorsthathaveaninfluenceonreturntoworkforthosewithstress,PTSD/anxietyandothermentalhealthconditionsOutcome:Returntowork(timetofirstreturntowork):patientwhoconsultedapsychologist,psychiatristsorchemist(prescription)interventionorreceivedcarethatdeviatedfromguidelinerecommendationwere17%to70%likelytotakelongertoreturntowork
PersonalRecoveryAnxietyanddepression
1104 RCT Notserious
None Notserious
Notserious
Singlestudy,Dutchcontext
86 77 1.1to3.6
Meandifference
Intervention:Socialworkerledprogram(“activatingandsupportingthepatienttorestorecopingandtoadoptaproblem-solvingapproachtowardhis/herproblems”)vs.GPusualcareOutcome:Personalrecovery(Symptomreductionmeasuredbyvariousinstruments[HADS,4DSQ,SF-36]–Nosignificantdifference,buttrendtowardssymptomimprovementsfromintervention
Stress,Depression
2107113 RCT Notserious
None Serious None Contextapplicability(Dutch&
125 120 0.03to1.8
- MOD Meandifference
76
QualityAssessment(GRADECriteria) No.ofparticipants Effect
GRADE CommentsMHC
No.ofstudies
StudyDesign
RiskofBias
Inconsistency
Indirectness
Imprecision
OtherConsiderations
Intervention(n)
Control(n)
Absolute
Relative
Danishsettings)
Interventions:Multidisciplinary/collaborativecare-teamscomprisingspecialistinoccupationmedicine,psychologists,caremanagevsGPusualcareOutcome:Personalrecovery(symptomreductionmeasuredbyvariousinstruments[SymptomChecklist92,PHQ-9])–non-significanteffect
Depression
1106 RCT Notserious
None Notserious
None Swedishstudy
30 35 -7.1(-29.6,16.3)
HIGH
Interventions:12-weekself-directedinternetbasedcognitive-basedtherapy(CBT)programvsusualcareOutcome:Personalrecovery(recoveryrates[BDI-II])–nodifferenceinrateofrecovery.Similarly,therewerenodifferenceinratesofdeterioration[-7.1(22.9,6.2)]orsuiciderisk[MADRSmeandifference-0.79(-5.11,3.53)]Asecondaryfollow-upstudyofpatientexperiencessuggestedtheself-directednessaspectoftheinterventionindicatedsomeparticipantsfounditfacilitatedpatientempowerment,personalresponsibilityandimprovemood,butothersfoundinterventionstressful
Depression;Depression+Anxiety
1105 RCT Notserious
None Notserious
None UKstudy -
CBTvsCounselling(BDI) 58 49 0(-3.75,3.75)
HIGH
CBTvsCounselling(SAS) 58 49 0.09(-0.11,0.29)
CBTvsCounselling(BSI) 58 49 0.18(-0.11,0.47)
CBTvsGP(BDI) 58 23 -2(-7.14,3.14)
CBTvsGP(SAS) 58 23 -0.05(-0.31,0.21)
CBTvsGP(BSI) 58 23 -0.1(-0.49,0.29)
77
QualityAssessment(GRADECriteria) No.ofparticipants Effect
GRADE CommentsMHC
No.ofstudies
StudyDesign
RiskofBias
Inconsistency
Indirectness
Imprecision
OtherConsiderations
Intervention(n)
Control(n)
Absolute
Relative
CounsellingvsGP(BDI) 49 23 -2(-6.2,2.2)
CounsellingvsGP(SAS) 49 23 -0.14(-0.41,0.13)
CounsellingvsGP(BSI) 49 23 -0.31(-0.70,0.08)
Interventions:Counselling,CBTandGPcare;internet-deliveredCBT(iCBT)vsusualcareOutcome:Personalrecovery(symptomreductionmeasuredbyvariousinstruments[BSI,BDI,SAS*])–Allinterventionsresultedinsignificantimprovementinsymptomsat12monthsandwereequallyaseffectiveaseachotherinreducingsymptomsat12months.
Depression,PTSD
2103112 Non-RCT
Serious
Notserious none none Moderatequalitynon-RCTs
226 237 LOW Non-RCTs
Interventions:Collaborativecare(nursing,alliedhealth;motivationalinterviewing,teaching,self-managementandinformationsharingwithprimarycareprovidersandpsychiatrists)andmultidisciplinaryassessmentandtreatmentprogramcomprisingreturntoworkcoordination,education,andreferraltospecialisedmentalhealthvsGPusualcareOutcome:Personalrecovery(symptomreductionmeasuredbyvariousinstruments[PHQ-9,MPSS*])–NosignificantdifferenceinPTSDsymptomsatsixmonthsinonestudy103andasignificantimprovementdepressivesymptomsfavouringinterventionatsixmonthsintheotherstudy112
depression,anxiety,andsomatizationdisorders
1114 RCT Notserious
none Notserious
none HighqualityRCT;Dutchcontext
74 57 - 1.16to1.21
MOD Non-significantoddsratios
Interventions:“E-healthmoduleembeddedincollaborativeoccupationalhealthcare”aimedat‘sicklistedemployees’cognitionsregardingreturntoworkwithphysicalorpsychologicalsymptomsandoptionstoresumeworkatleastonapartialbasiswhilesymptomsarestillpresent,plusemaildecisionaidfortreatingoccupationalphysiciansvsOPusualcareOutcome:Personalrecovery(remission):nodifferenceinsymptomremissionorresponse
Depression
1112 Non-RCTs
Serious
Notserious none Notserious
Moderatequalitynon-RCTs
158 179 21.2%(10.8,31.2)
- LOW
Interventions:Collaborativecare(nursing,alliedhealth;motivationalinterviewing,teaching,self-managementandinformationsharingwithprimarycareprovidersandpsychiatrists)Outcome:Personalrecovery(remissionrates):significantsymptomremissionatsixmonthsinfavourofthecollaborativecarevsGPusualcare
78
QualityAssessment(GRADECriteria) No.ofparticipants Effect
GRADE CommentsMHC
No.ofstudies
StudyDesign
RiskofBias
Inconsistency
Indirectness
Imprecision
OtherConsiderations
Intervention(n)
Control(n)
Absolute
Relative
Depression
1111 RCT Serious
None None serious LowqualityRCT
107 131 0.9 Non-significantmeandifferenceof0.9monthslessforcomparatorthanintervention
Interventions:Enhancedprimarycareintervention(physiciansandcaremanagerstrainedinguidelinesbasedmanagementofdepression)Outcome:Personalrecovery(other–antidepressantuse);Onelowqualitystudy,noevidencethatanenhancedprimarycaremanagementprogramreducedthenumberofmonthsofantidepressantuse
Adjustmentdisorder
1115 RCT None None Notserious
Serious Contextapplicability(Dutch)
85 68 - - HIGH
Interventions:seeaboveOutcome:Personalrecovery–psychopathologysymptoms(4DSQandSCL-90):Nodifferenceatthreeand12months;CHIME(meaninginlife,Empowerment)proxy(MasteryScale“…lifechangesasbeingunderhisorhercontrol…”)–nodifferenceatthreeand12months
Psychologicaldistressorburnout
1117 RCT Notserious
Noserious Serious Serious Includesburnout;Norwegiancontext
25 15 15.5 LOW Significantmeandifferenceinfavourofintervention
Interventions:seeaboveOutcome:Personalrecovery(healthstatus-SF-36MentalHealthdimension)–better(mental)healthstatusfollowinginthementalhealthsubgroupatsixmonths
*Acronymsofassessmenttools:4DSQ–4-DimensionalsymptomquestionnaireBSI-BriefSymptomInventoryBDI-BeckDepressionInventoryHADS–HospitalanxietyanddepressionscaleMPSS-ModifiedPTSDSymptomScalePHQ-9–Patienthealthquestionnaire-9itemSAS-SocialAdjustmentScaleSCL-90–SymptomChecklist-90Item
79
Table24.Listofexistingsystematicreviewsaddressingkeyclinicalquestion4
ReviewTitle ReviewAuthor Reviewtype AMSTARscore#
Effectivenessofworkplaceinterventionsinreturn-to-workformusculoskeletal,pain-relatedandmentalhealthconditions:anupdateoftheevidenceandmessagesforpractitioners
Cullenetal2017120 Systematicreview
7
Interventionsforenhancingreturntoworkinindividualswithacommonmentalillness:systematicreviewandmeta-analysisofrandomizedcontrolledtrials
Nigatuetal2016121 Systematicreview
7
Interventionstoimprovereturntoworkindepressedpeople
Nieuwenhuijsenetal2014122
Cochranesystematicreview
10
Interventionstofacilitatereturntoworkinadultswithadjustmentdisorders
Arendsetal2012123 Cochranesystematicsreview
10
Improvingthemanagementofdepressioninprimarycare
Brody2003 Narrativereview (notextracted)
4
#Scoresoutofatotalof11
Inadditiontotheevidencefromprimarystudiesoutlinedintheevidencetable(Table23),afurther targeted search for systematic reviews and meta-analyses was performed inEmbase,Medline,PsycINFOandAMEDfrominceptiontothe6thofNovember2017.Sevenrelevant reviewswere included (Figure 19). One of the excluded reviewswhich exploredreturn to work outcomes 124 included six studies; four of which we included in oursystematic reviewand twoweexcluded.This systematic reviewwas considered in searchroundoneandexcludedtoavoidduplicationwithoursystematicreviewfindings.
TheincludedreviewsvariedinqualitywithAMSTARscoresrangingfromzerotonine.Riskofbias was high mainly due to a literature search strategy that was not comprehensive,methodsnotspecifyingduplicatescreening/dataextraction,andlackofcharacteristicsandqualityassessmentofstudiesincludedinthereviews.Themainfindingscentredonpersonalrecoveryoutcomes(symptomimprovements)inpatientswithdepression125-127,anxiety128129 or othermental disorders and/or addictive disorders 130131. A summary of findings ispresentedinTable25.
80
Figure 19. PRISMA chart of additional screening and review for meta-analyses and reviews forquestion4
81
Table25.Summaryevidencetableofsystematicreviewsthataddressedthescopeforkeyclinicalquestion4
Intervention:PharmacotherapyormultifacetedinterventionfordepressionOutcome:Personalrecovery(symptomresponseorremission)
Review Reviewtype AMSTARscore
MainFindings RiskofBias GRADE
Pharmacologicaltreatmentofdepression.ConsultingwithDrOscar126
Narrativereview
0 SingledatabasesearchedtoJan1999,unclearhowmanytrials/studieswereincluded:Astep-upapproachunderpinnedbyoptimisingantidepressantdoseandallowingsufficienttimeforantidepressanttowork;wherethereisnoresponsetotreatmenttoconsiderchangingtheantidepressantorcombiningdifferentclassesoraugmentation(i.e.withlithium,thyroidhormonesetc.).Theauthoracknowledgedthatfurtherevidenceofefficacyinrelationtoswitchingantidepressantsoraugmentationwasrequired.
High LOW
Identificationandmanagementofdepressioninprimarycaresettings.Ameta-reviewofevidence125
Narrativemeta-review
0 Ameta-reviewofsystematicreviews,unclearhowmanyreviewswereincluded:Nodifferenceinselectiveserotoninreuptakeinhibitors(SSRIs)andTri-cyclicantidepressants(TCAs)andfurtherindicatedtherewasalackofevidencefortheefficacyofantidepressantsinprimarycaresettingformilddepression.
High LOW
Chronicdiseasemanagementfordepressioninprimarycare:asummaryofthecurrentliteratureandimplicationsforpractice127
Systematicreview
2 Unclearhowmanytrials/studieswereincluded:“Multifacetedinterventions[providereducation,screening,psychiatricconsultation,usingtreatmentalgorithms,casemanagement,relapsepreventionplans,registriesetc.]havedemonstratedtheireffectivenessinimproving(symptomremission,depressionscores)outcomesfordepressionpatientsseenandtreatedinprimarycaresettings.Althoughitisnotclearwhichcomponentsofthesemultifacetedinterventionsaremostlikelytobringaboutbeneficialoutcomes"
High LOW
Intervention:ExerciseforanxietydisorderOutcome:Personalrecovery(symptomresponseorremission)
Exerciseforanxietydisorders:systematicreview129
Systematicreview
8 FindingsfromeightRCTsofavarietyofexerciseinterventions(structured,verylight,walking,strenuous,weightlifting),nodetailsoffrequencyordurationofintervention,follow-uprangingfromeightweeksto10months:Regardlessoftype
Low HIGH
82
(aerobicvsnon-aerobic),exercisemayreduceanxietysymptomsbutislesseffectivethanantidepressantsbutmaybeusefulas“anadjunctivetreatmentforanxietydisorders”ratherthanasubstituteforantidepressant.TheauthorsstatethatfurtherwellconductedRCTsareneeded.
Effectsofaerobicexerciseonanxietydisorders:asystematicreview128
Systematicreview
7 Included10studies,85%reportedhighriskofbias:Comparedtoplaceboexercisemaysignificantlyimproveclinicaloutcomesbutislesseffectivethanantidepressants,thus"Exercisecannotreplaceconventionaltreatments,suchasSSRIsorCBT,though,canstillberecommendedasanadditionaltreatmentmodality."
High LOW
Intervention:MultidisciplinarycareOutcome:Personalrecovery(abstinence)
Improvinggeneralmedicalcareforpersonswithmentalandaddictivedisorders:systematicreview131
Systematicreview
5 InformedbyonlytwooutofsixincludedRCTsfrom1999and2001respectively:• Careprovidedbyprimarycaremedicalpractitionerandexpert
addictioncounsellor:Ratesofabstinencefromalcoholismweresignificantlygreaterintheintervention(75%vs48%)inmedicallyillpatientswithalcoholism.
• Careprovidedprimarycaremedicalpractitioner,medicalassistant,andnurse:Nodifferenceinabstinenceoverallbutasubgroupofthosewithaddictiverelatedmedicalandmentaldisordersalsoshowedsignificantlygreaterabstinentrates(69%vs55%),whiletherewasnodifferenceinthefullgroupwithaddictionandothercomorbidities.
Unclear LOW
Intervention:PrimarycarephysicianstrainedinCBTfordepressionandanxietyOutcome:Personalrecovery(depressionandanxietysymptoms)
Trainingprimarycarephysiciansincognitivebehavioraltherapy:Areviewoftheliterature130
Systematicreview
4 TwooutofnineincludedstudiesevaluatedtheeffectofprimarycarephysicianstrainedinCBTonpatients'mentalhealthconditionoutcomes.Oneshowedasignificantimprovementinglobalpsychologicaldistress,theotherfoundnodifferenceondepressionandanxietyoutcomes.
Unclear LOW
83
7 Keyclinicalquestion5:Inpatientswithadiagnosisofawork-relatedmentalhealthcondition,whatfeatures(factors)leadtodelayedprogressinthepatient’scondition?
7.1 Evidencereviewroundone 7.1.1 PICO
PPatientswithwork-relatedmentalhealthconditionsISymptomsandsignsthatindicatepoorrecovery,e.g.riskfactorsabout
chronicityCSymptomsandsignsthatdonotindicatepoorrecoveryOEarlydetectionofslowpatientrecovery,patientsatisfaction(regarding
recovery)
7.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
1. ((Mentaladjhealth)or(Psychiatricadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*))or(Mentaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Psychologicaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Depressiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(Moodadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Affectiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Adjustmentadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Posttraumaticadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AnxietyorstressorDepressionorVicarioustrauma)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
2. ((((Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor((joborworkoremploymentortrade)adjrelated)oroccupational)adj(disease*orillness*orhealth))orCompensation)adj(claim*orcompensation)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
3. (((Delay*orslow*orrapid*orquick*orlate*)adj(progress*orrecover*orrespon*))orevaluation*or(PrognosisorRecover*orRespon*)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
4. 1and2and3
84
7.1.3 SearchStrategy:CINAHL
# Query Limiters/Expanders
S1
“Mentalhealth”or(PsychiatricAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*))or(MentalAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(PsychologicalAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(DepressiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(MoodAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AffectiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AdjustmentAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or((“Posttraumatic”ORtraumatic)AND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))orAnxietyorstressorDepressionor“Vicarioustrauma”
Searchmodes-Boolean/Phrase
S3
(GeneralAND(practi*orphysician*ordoctor))or(FamilyAND(practi*orphysician*ordoctor*))or(Familymedic*(practi*ordoctor*))or(“Primarycare”AND(practi*orphysician*ordoctor*))or(“Occupationalhealth”AND(practi*orphysician*ordoctor*orspecialist*))or“companyphysician*”
Searchmodes-Boolean/Phrase
S4
Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor“jobrelated”or“workrelated”or“employmentrelated”or“traderelated”or“occupationaldisease*”or“occupationalillness*”or“occupationalhealth”orCompensationorclaim*
Searchmodes-Boolean/Phrase
S6"Returntowork"orRecov*orImprov*orResol*orresolv*orRespon*oroutcome*or"treatmentoutcome*"
Searchmodes-Boolean/Phrase
S8((Delay*ORslow*ORrapid*ORquick*ORlate*)AND(progress*ORrecover*ORrespon*))ORevaluation*ORPrognosisORRecover*ORRespon*
Searchmodes-Boolean/Phrase
S13
"Returntowork"OREvaluation*ORDecision*ORPrognosisORIndicat*ORGuide*ORmarker*ORAbsenteeismOR"Sick*leave"OR"Sicknesscertificat*"OR"WorkScheduleTolerance*"OR"Workperformance*"OR"Workabilit*”OR“workcapacit*”OR“workdisabilit*”OR“workread*”OR“Modifiedwork”OR“modifieddut*”OR“Workread*”
Searchmodes-Boolean/Phrase
S25 S1ANDS4ANDS6ANDS8ANDS13Searchmodes-Boolean/Phrase
S26 S3ANDS25Searchmodes-Boolean/Phrase
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7.1.4 Searchperiod Databaseinceptiontothe31stofJanuary2017.
7.1.5 PRISMAroundone
Embase,Medline,PsycINFOandAMEDreturnedn=80recordsandCINAHLreturnedn=1300records.
Figure20.RoundonePRISMAchartforkeyclinicalquestion5
7.2 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting
- ReviseKeyclinicalquestion5toread:“Inpatientswithadiagnosisofawork-relatedmentalhealthconditionwhatfactorsadverselyaffectprogressinthepatient’scondition?”
- Outcomesof5toberevisedto“personalrecovery”and“returntowork”(asperKeyclinicalquestion4).
- Remove‘work-relatedness’fromsearchstrategyandincludeeightstudiesthatwereoriginallyexcluded.
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7.3 Evidencereviewroundtwo
7.3.1 PICO
PPatientswithawork-relatedmentalhealthconditionISignsandsymptomsofdelayedrecoveryCSignsandsymptomsthatdonotindicatedelayedrecoveryOPersonalrecovery,returntowork
7.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
1. ((Mentaladjhealth)or(Psychiatricadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*))or(Mentaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Psychologicaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Depressiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(Moodadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Affectiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Adjustmentadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Posttraumaticadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))orAnxietyorstressorDepression).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
2. (((Delay*orslow*orrapid*orquick*orlate*)adj(progress*orrecover*orrespon*))orevaluation*or(PrognosisorRecover*orRespon*)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
3. (Recov*orImprov*orResolution*orresolv*orRespon*oroutcome*orprogressor(personaladjrecovery)orCHIMEorconnectednessorhopeoroptimismoridentityor(meaningadj2life)orempowermentor(treatmentadjoutcome*)or(failureadj2improve)or((patientorworkeroremployee)adj(healthorwellbeing))).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
4. ((Return*adj2work)orrtworAbsenteeismorSickleaveorSicknesscertificat*orWorkScheduleTolerance*orWorkperformance*or(Workadj(abilit*orcapacit*ordisabilit*orread*))or(suitableadjdut*)or(alternativeadjdut*)or(Modifiedadj(workordut*))or(Workadjread*)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
5. 1and2and(3or4) 6. ((((Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*or
employmentorjobortradeor((joborworkoremploymentortrade)adjrelated)oroccupational)adj(disease*orillness*orhealth))orCompensation)adj(claim*orcompensation)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
7. 5and6
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7.3.3 SearchStrategy:CINAHL
# Query Limiters/Expanders
S1
“Mentalhealth”or(PsychiatricAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*))or(MentalAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(PsychologicalAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(DepressiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(MoodAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AffectiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AdjustmentAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or((“Posttraumatic”ORtraumatic)AND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))orAnxietyorstressorDepression
Searchmodes-Boolean/Phrase
S3
(GeneralAND(practi*orphysician*ordoctor))or(FamilyAND(practi*orphysician*ordoctor*))or(Familymedic*(practi*ordoctor*))or(“Primarycare”AND(practi*orphysician*ordoctor*))or(“Occupationalhealth”AND(practi*orphysician*ordoctor*orspecialist*))or“companyphysician*”
Searchmodes-Boolean/Phrase
S4
Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor“jobrelated”or“workrelated”or“employmentrelated”or“traderelated”or“occupationaldisease*”or“occupationalillness*”or“occupationalhealth”orCompensationorclaim*
Searchmodes-Boolean/Phrase
S6"Returntowork"orRecov*orImprov*orResol*orresolv*orRespon*oroutcome*or"treatmentoutcome*"
Searchmodes-Boolean/Phrase
S8((Delay*ORslow*ORrapid*ORquick*ORlate*)AND(progress*ORrecover*ORrespon*))ORevaluation*ORPrognosisORRecover*ORRespon*
Searchmodes-Boolean/Phrase
S13
"Returntowork"OREvaluation*ORDecision*ORPrognosisORIndicat*ORGuide*ORmarker*ORAbsenteeismOR"Sick*leave"OR"Sicknesscertificat*"OR"WorkScheduleTolerance*"OR"Workperformance*"OR"Workabilit*”OR“workcapacit*”OR“workdisabilit*”OR“workread*”OR“Modifiedwork”OR“modifieddut*”OR“Workread*”
Searchmodes-Boolean/Phrase
S25 S1ANDS4ANDS6ANDS8ANDS13Searchmodes-Boolean/Phrase
S26 S3ANDS25Searchmodes-Boolean/Phrase
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7.3.4 Searchperiod
Databaseinceptiontothe30thofApril2017.
7.3.5 PRISMAroundtwo
Embase,Medline,PsycINFOandAMEDreturnedn=285recordsandCINAHLreturnedn=1325records.
Figure21.CombinedroundoneandroundtwoPRISMAchartforkeyclinicalquestion5
7.4 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion5
Table26.Keyclinicalquestion5literaturesearchresultsandimplicationsarisingfromsearchstringsusedinrelationtowork
EvidenceReviewRounds
Originalkeyclinicalquestion5.Inpatientswithadiagnosisofawork-relatedmentalhealthcondition,whatfeatures(factors)leadtodelayedprogressinthepatient’scondition?
Ovidimplication CINAHLimplication
OVIDcount
CINAHLcount
R1 - Mentalhealthconditions(includedvicarioustrauma)
- Work-relatedness- Delayedprogress
Workinthecompensablesetting
work 80
1300
Ifwork-relatedness Work 149450 Noimpact
89
searchstringhadbeencorrectedto“work”
R2 RevisedKeyclinicalquestion:Inpatientswithadiagnosisofawork-relatedmentalhealthconditionwhatfactorsadverselyaffectprogressinthepatient’scondition?- Mentalhealthconditions
(excludedvicarioustrauma)
- Work-relatedness- Delayedprogress(included
failuretoimprove)- Returntowork(included
alternativeduties)- Inception–30thApril2017
Workinthecompensablesettingremoved
Workremoved 1641352 4344
Workinthecompensablesetting
work 285 1325
Ifwork-relatednesssearchstringhadbeencorrectedto“work”
Work 4187 Noimpact
EvidenceReviewGroupRecommendation:ForKeyclinicalquestion5thelargenumberofhitsinOvidthatwouldhaveoccurredasaresultofthesearchstringerrorcorrectionwouldhavemadethesearchunfeasible.OurrecommendationistoacceptthefinalrecommendationasperGuidelineDevelopmentGroupmeeting3.
7.5 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:Keyclinicalquestion5
Elevenprimarystudies 53108109132-139,asystematic review140andother typeof review141,mettheinclusionforkeyclinicalquestion5.ThesestudiesandtheirqualityappraisalresultsarelistedinTable27,Table28and
Table 29. The review identified factors thatmay be associated with adverse progress asinferred from delayed return to work and personal recovery. These factors related toworkplace, personal/psychosocial, and medical/health attributes which can act asprognostic red flags at assessment and evaluation. Overall evidence from the primarystudies is presented in Table 30. The two review papers 140141 identified similar factors,althoughBlanketal.140concludedthattherewaslittlerobustevidenceaboutwhatfactorscarrythegreatestriskforsicknessabsence.
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Table27.DownsandBlackChecklistqualityassessmentscoresforstudiesincludedinkeyclinicalquestion5
Reporting(Overallstudyquality)
Externalvalidity
Internalvalidity(Studybias)
Internalvalidity(Confoundingandselectionbias)
Powerofstudy
Total
Aakviketal2010132 10 3 4 2 0 19
Andersonetal2011133 10 3 4 3 0 20
Brouwersetal2009135 8 3 7 6 0 24Dollardetal1999136 6 2 0 1 0 9
Engblometal2009137 6 3 4 2 0 15
Nieuwenhuijsenetal2003108
8 3 4 3 0 18
Prangetal2016109 9 0 5 4 0 18
Bryngelsonetal2012139 8 3 5 4 0 20
Russelletal199553 6 1 5 4 0 16
Salmietal2009138 8 3 3 3 0 17
Mean 7.9 2.4 4.1 3.2 0.0 17.6
SD 1.5 1.1 1.8 1.4 0.0 3.9
Table28.AdaptedCASPqualitychecklistassessmentofqualitativestudiesincludedinkeyclinicalquestion5
CASPDomain Brijnathetal2014134Researchdesign 3
Sampling 2Datacollection 2Dataanalysis 7
Findings/Results 5Researchvalue 6
Total(/26) 25Suitability Highvalue
Table29.Listofexistingreviewsaddressingkeyclinicalquestion5
ReviewTitle ReviewAuthor Methodused AMSTARscore
Asystematicreviewofthefactorswhichpredictreturntoworkforpeoplesufferingepisodesofpoormentalhealth
Blanketal2008140 Systematicreview
7
Workandcommonpsychiatricdisorders Hendersonetal2011141 Narrative non-systematicreview
0
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Table30.GRADEEvidenceProfileTable:Inpatientswithadiagnosisofawork-relatedmentalhealthcondition,whatfactorsadverselyaffectprogressinpatient’scondition?
QualityAssessment(GRADECriteria) Effect GRADE CommentsMHC No.of
studies(n)
StudyDesign
RiskofBias
Inconsistency
Indirectness
Imprecision OtherConsiderations
No.ofpatients
Absolute
Relative
Minormentalhealthcondition(i.e.distress,depression,anxietyandsomatisation)
1135 RCT none notserious
notserious
notserious singlestudy 194 - 0.275to0.926
HIGH Lowodds(OR)ofreturningtoworkwithin6months
Outcomes:Personalrecoveryandreturntowork–factorssignificantlyassociatedwithloweroddsofreturningtoworkby6months• Persistentsymptomspriortogoingonsickleave• TypeandseverityofMHCsymptoms(i.e.Anxietyvs.depression,somatization)withgreaterdepressivesymptomsassociatedwithnon-
returntoworkat6months.• Absenteeism>3weeksattimeofevaluation
PTSD,depression,andanxietydisorder,stress,adjustmentdisordersandotherunspecifiedMHC/psychiatricdiagnoses
953108109132-
134137-
139142
Cross-sectional/cohort/casecontrol
Serious Serious Notserious
serious Severalstudiesfromavaryinghealthcaresystems
365593 - - HIGH Includetwolargesecondarydatabaseanalysis
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Outcomes:Returntoworkandpersonalrecovery–factorsassociatedwithdelayedreturntoworkand/orrecovery:• Employmentsectors:Agriculture,construction,wholesaleandretail,financialservices,• Employment/workplace:supervisoremployercommunication,harassmentandbullyingasprecursortomentalhealthcondition;
job/workstress• "...typeofstressprecipitant..."i.e."criticalincident"plus"chronicworkstressors"ledtolengthysickleave/delayedreturntowork• Socioeconomicfactors:education,income/lowpay,workexperience,andworkinghours;riskofunemploymenthasaninfluenceonthe
typeandlengthofsicknesscertification
• Medicalfactors:Greatermentalhealthconditionsymptomseverity(i.e.GHQ-28,DerogatisStressProfile)wasassociatedwithfailuretoreturntoworkwithinfourmonths;extensivephysicalinjury,chronicpain;qualityofrehabilitationservices;workerswhoconsultedpsychiatrist,psychologistorchemistweremorelikely(12-46%)totakelongertoreturntoworkwithinatwo-yearperiod;Drugtreatmentandphysiotherapywereassociatedwith75-79%likelytobeonsicknessabsenceformorethan90days
• Healthbehaviours:Alcoholintake,smoking,drugdependence,overweight,underweight,negativemindsettowardsrecovery
• Personal/patientfactors:Stressfullifefactorsoutsideofwork;olderage(>40)wasassociatedwithanegativeprognosisofreturntoworkwithintwoyearsandthesepatientswerelessoftenrecommendedadditionalrehabilitation"
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8 Keyclinicalquestion6:Inpatientswithwork-relatedmentalhealthconditionswhoarenotimproving,whatstrategiesshouldageneralpractitionerundertaketoimprovethepatient’scondition?
8.1 Evidencereviewroundone 8.1.1 PICO
PPatientswithwork-relatedmentalhealthconditionsIReview(holistic),(includebarriers)CAssessmentuponinitialpresentationOPatientrecovery,patientsatisfaction
8.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
1. ((Mentaladjhealth)or(Psychiatricadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*))or(Mentaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Psychologicaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Depressiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(Moodadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Affectiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Adjustmentadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Posttraumaticadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AnxietyorstressorDepressionorVicarioustrauma)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
2. ((Generaladj(practi*orphysician*ordoctor))or(Familyadj(practi*orphysician*ordoctor*))or(Familyadjmedic*adj(practi*ordoctor*))or(Primaryadjcareadj(practi*orphysician*ordoctor*))or(((Occupationalhealthadj(practi*orphysician*ordoctor*orspecialist*))orcompany)adjphysician*)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
3. ((((Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor((joborworkoremploymentortrade)adjrelated)oroccupational)adj(disease*orillness*orhealth))orCompensation)adj(claim*orcompensation)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
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4. (Strateg*orIntervention*orTreatment*orCare*ormanag*orapproach*ordecision*oraction*orTherap*orrefer*).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
5. 1and2and3and4
8.1.3 SearchStrategy:CINAHL
# Query Limiters/Expanders
S1
“Mentalhealth”or(PsychiatricAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*))or(MentalAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(PsychologicalAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(DepressiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(MoodAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AffectiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AdjustmentAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or((“Posttraumatic”ORtraumatic)AND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))orAnxietyorstressorDepressionor“Vicarioustrauma”
Searchmodes-Boolean/Phrase
S3
(GeneralAND(practi*orphysician*ordoctor))or(FamilyAND(practi*orphysician*ordoctor*))or(Familymedic*(practi*ordoctor*))or(“Primarycare”AND(practi*orphysician*ordoctor*))or(“Occupationalhealth”AND(practi*orphysician*ordoctor*orspecialist*))or“companyphysician*”
Searchmodes-Boolean/Phrase
S4
Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor“jobrelated”or“workrelated”or“employmentrelated”or“traderelated”or“occupationaldisease*”or“occupationalillness*”or“occupationalhealth”orCompensationorclaim*
Searchmodes-Boolean/Phrase
S5Strateg*orIntervention*orTreatment*orCare*ormanag*orapproach*ordecision*oraction*orTherap*orrefer*
Searchmodes-Boolean/Phrase
S6"Returntowork"orRecov*orImprov*orResol*orresolv*orRespon*oroutcome*or"treatmentoutcome*"
Searchmodes-Boolean/Phrase
S8((Delay*ORslow*ORrapid*ORquick*ORlate*)AND(progress*ORrecover*ORrespon*))ORevaluation*ORPrognosisORRecover*ORRespon*
Searchmodes-Boolean/Phrase
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S27 S1ANDS3ANDS4ANDS5ANDS8Searchmodes-Boolean/Phrase
S28 S6ANDS27Searchmodes-Boolean/Phrase
8.1.4 Searchperiod
Databaseinceptiontothe31stofJanuary2017.
8.1.5 PRISMAround1
Embase,Medline,PsycINFOandAMEDreturnedn=4recordsandCINAHLreturnedn=1879records.
Figure22.RoundonePRISMAchartforkeyclinicalquestion6
8.2 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting
- Include24studies(thatwereoriginallyexcludedfromfulltextreviewduetonotaddressingwork-relatedness)
- Includestudiesthatdon’tfocusspecificallyonGPs.
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- Removework-relatednessandgeneralpractitionerfromthesearchstrategy(work-relatednessreturnedto“re-narrow”thesearch).
- Addtothesearchstrategy:treatmentresistance,andfailuretoimprove.
8.3 Evidencereviewroundtwo
8.3.1 PICO
PPatientswithwork-relatedmentalhealthconditionsIStrategiesCAllstrategiesONon-improvement
8.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
1. ((Mentaladjhealth)or(Psychiatricadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*))or(Mentaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Psychologicaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Depressiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(Moodadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Affectiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Adjustmentadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Posttraumaticadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))orAnxietyorstressorDepression).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
2. (Strateg*orIntervention*orTreatment*orCare*ormanag*orapproach*ordecision*oraction*orTherap*orrefer*).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
3. (((Delay*orslow*orrapid*orquick*orlate*)adj(progress*orrecovery))or(treatmentadjresistance)orrespon*orevaluation*orPrognosisor(fail*adj2improve*)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
4. ((((Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor((joborworkoremploymentortrade)adjrelated)oroccupational)adj(disease*orillness*orhealth))orCompensation)adj(claim*orcompensation)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
5. 1and4 6. 2and3and5
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8.3.3 SearchStrategy:CINAHL
# Query Limiters/Expanders
S1
“Mentalhealth”or(PsychiatricAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*))or(MentalAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(PsychologicalAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(DepressiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(MoodAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AffectiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AdjustmentAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or((“Posttraumatic”ORtraumatic)AND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))orAnxietyorstressorDepression
Searchmodes-Boolean/Phrase
S4
Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor“jobrelated”or“workrelated”or“employmentrelated”or“traderelated”or“occupationaldisease*”or“occupationalillness*”or“occupationalhealth”orCompensationorclaim*
Searchmodes-Boolean/Phrase
S5Strateg*orIntervention*orTreatment*orCare*ormanag*orapproach*ordecision*oraction*orTherap*orrefer*
Searchmodes-Boolean/Phrase
S6"Returntowork"orRecov*orImprov*orResol*orresolv*orRespon*oroutcome*or"treatmentoutcome*"
Searchmodes-Boolean/Phrase
S8
((Delay*ORslow*ORrapid*ORquick*ORlate*)AND(progress*ORrecover*ORrespon*))ORevaluation*ORPrognosisORRecover*ORRespon*OR“treatmentresistance”or“failuretorecover”
Searchmodes-Boolean/Phrase
S27 S1ANDS4ANDS5ANDS8Searchmodes-Boolean/Phrase
S28 S6ANDS27Searchmodes-Boolean/Phrase
8.3.4 Searchperiod
Databaseinceptiontothe30thofApril2017
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8.3.5 PRISMAroundtwo
Embase,Medline,PsycINFOandAMEDreturnedn=131recordsandCINAHLreturnedn=1923records.
Figure23.CombinedroundoneandroundtwoPRISMAchartforkeyclinicalquestion6
8.4 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion6
Table31.Keyclinicalquestion6literaturesearchresultsandimplicationsarisingfromsearchstringsusedinrelationtowork
EvidenceReviewRounds
Originalkeyclinicalquestion6.Inpatientswithwork-relatedmentalhealthconditionswhoarenotimproving,whatstrategiesshouldageneralpractitionerundertaketoimprovethepatient’scondition(e.g.identifyrecurrent/continuingstressors,newsymptoms/signs,newcomorbiditiessuchasD&Ause)
Ovidimplication CINAHLimplication
OVIDcount
CINAHLcount
R1 - Mentalhealthconditions(includedvicarioustrauma)
Workinthecompensable
work 4
1879
99
- Generalpractice- Work-relatedness- Strategiesfornon-improvement
setting
Ifwork-relatednesssearchstringhadbeencorrectedto“work”
Work 8673 Noimpact
R2 - Nochangetokeyclinicalquestionmade.
- Mentalhealthconditions(excludedvicarioustrauma)
- Generalpractice- Work-relatedness- Non-improvement(included
treatmentresistance,failuretoimprove)
- Strategies- Inception–30thApril2017
Workinthecompensablesetting
work 131
1923
Ifwork-relatednesssearchstringhadbeencorrectedto“work”
Work 100609 Noimpact
EvidenceReviewGroupRecommendation:ForKeyclinicalquestion6thelargenumberofhitsinOvidthatwouldhaveoccurredasaresultofthesearchstringerrorcorrectionwouldhavemadethesearchunfeasible.OurrecommendationistoacceptthefinalrecommendationasperGuidelineDevelopmentGroupmeeting3.Asaconsequenceofanerrorintheworkconceptsearchstrategy(seemethodssection4.4)the Guideline Development Group advised the project team to consider a targetedscreening forsystematic reviewsandmeta-analysiswithinthen=8673searchresults (seetableabove).Therefore,thesearchresultsfromthefourOviddatabases(AMED,EMBASE,MEDLINE and PsycINFO)were retrieved on the 11th of October 2017 (a later datewhichyieldedslightlymorethantheoriginalresultofn=8673).Thisroundofreviewreturnednorelevantreviewsforinclusion.ThesearchresultsareshowninFigure24andanexplanationofthereviewprocessandoutcomeisdetailedbelow.Inordertostreamlinescreeningtosystematicreviewsandmeta-analyses,limitationswereapplied to the approximately n=8770 search results. The limitations were performed inthreestages:
1. Using theOvid inbuilt auto limits, “Meta-Analysis” and “Systematic Reviews.” Thepro for this approach is that it is much more specific and limits publications tosystematicreviewsandmeta-analysisonlyasstudydesignmethods.Theconisanyreviews that are general and are not classified as systematic or meta-analytic in
100
design are excluded. Also, the limits are not valid in AMED andMEDLINE in OvidwhichmeanspublicationsindexedinAMEDandMEDLINEareexcluded.
2. Manually including the limit search terms as additional key words in the searchstrategy.Thisapproachissensitivebutpooronspecificity.Itdoesnotconfineitselftosystematicreviewand/ormeta-analysisasstudydesignmethodsbutpicksupthesearch terms as long as they appear in thepublication (regardless ofwhether thepublication/studyitselfisasystematicreviewand/ormeta-analysisinitsdesign).
3. Finally, the two approaches were checked for overlaps. This showed that 82publications from the first approachwere a subset of the 1324 (manually limitedsearch),resultinginacombinedtotalofn=1342.
Figure24.Flowchartshowingresultsandoptionwhenmeta-analysisorsystematicreviewslimitsareappliedtothesearch
Further deduplication in EndNote resulted in n=1112 titles/abstracts. The titles/abstractswere thenmergedwith titles fromprevious reviewsandpreviously screenedpublicationswere removed leaving n=1064 which were then exported to Covidence for screening.Another15duplicateswereflaggedbyCovidenceleavingafinalscreeninglistofn=1049.Screeninginclusioncriteriawere:
• Quantitative,qualitativeandnarrativesystematicreviewsand/or• Meta-analysis,and• Theinterventionshadtoaddressthenon-improvingpatientscope.
Screeningexclusioncriteriawere:
• Publicationsofprimaryresearch,• Non-systematicexpertopinion/reviewsandcommentaries,
RecordsidentifiedthroughOvidsearchon11Oct2017
(n=8770)
Recordsafterduplicatesremoved&limitedtoEnglishlanguageinOvid
(n=7085)
Applyingmeta-analysis,systematicreviewlimitsmanually
(n=1342)
Applyingmeta-analysis,systematicreviewOvidlimits
(n=101)
101
• Systematic reviews and/or meta-analyses of interventions aimed at primarytreatmentofmentalhealthconditionsratherthantheotherendofthespectrumofnon-improvingortreatmentresistantmentalhealthconditions.
The results of the screening/reviewprocess are shown in Figure 25. A total of 22 paperswereselectedforfulltextreview(seelistofpapersinAppendixB).The16publicationsthatwere excluded for not answering questions 6 were largely due to a different patientpopulation (i.e. not the non-improving patients) or the interventions were system orpractice performance targeted rather than patient and patient outcomes targeted. Theremaining six publications were non-systematic reviews (commentary, clinical focus orexpertopinions,non-systematicoverviewliteraturereview).
Figure25.PRISMAchartofadditionalscreeningandreviewformeta-analysesandreviewsforquestion6
8.5 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:Keyclinicalquestion6
Sixstudies 143-148 (Table32)andtwonon-systematicnarrativereviews149150 (Table33)mettheinclusionforkeyclinicalquestion6.EvidencefromtheprimarystudiesissummarisedinTable34.Theevidenceidentifiedserviceprovisionandtherapeuticinterventionalstrategiesthatwereassociatedwithincreasedprospectsofpatientrecoveryandsatisfaction.Limitedevidenceidentifiedmedicationcomplianceandmedico-psychosocialfactorsthatpotentially
102
contribute to poorer recovery and may be worthwhile considering for decision makingaround formulating care and management plans. While no causality is implied in theassociation between non-return to work, and disability recurrence with persistentdepression,thefindingsmayhaveimplicationsforthetypeofsicknesscertificationvis-à-vistheideaof“workasrehabilitation.”
Table32.DownsandBlackChecklistqualityassessmentscoresforstudiesincludedinkeyclinicalquestion6
Reporting(Overallstudyquality)
Externalvalidity
Internalvalidity(Studybias)
Internalvalidity(Confoundingandselectionbias)
Powerofstudy
Total
Fortneyetal2013 9 3 5 5.5 0 22.5Francheetal2009 9.5 2.5 4 3 0 19Rzewuskaetal2015 9.5 3 4 3.5 0 20Tehetal2009 8 2.5 4.5 4 0 19Thompsonetal2000 9.5 2.5 5 5 0.5 22.5Wilesetal2014 11 3 5 5 0.5 24.5
Mean 9.4 2.8 4.6 4.3 0.2 21.3SD 1.0 0.3 0.5 1.0 0.3 2.3
Thetworeviews149150thatmetthescopeforourkeyclinicalquestionscoredverylowontheAMSTARscoresanddidnotspecificallyaddressoutcomespertainingtoourkeyclinicalquestion. Nevertheless, they provided a qualitative narrative of factors to consider inpatientswithdepressionthatdoesnotrespondstoantidepressant.Thesefactorsinclude:
• Differential diagnosis (i.e. adjustment disorder, bereavement, cognitive disorder,personality style, or dysthymia). For instance, cognitive dysfunction may be "theprimary driver of disability and work impairment among our patients with majordepressivedisorder”,thusmaybeworthwhileassessingusingvalidatedinstrumentsineverydepressedpatient.
• Monitoringcompliancewithmedication;“asmanyas70%ofprimarycarepatientsfailtoadheretoeithershort-orlong-termADtreatment”duetoside-effects.
• Review of treatment strategies, i.e. aggressivelymanaging side effects in order toimproveadherenceand"abarrageofnegativethinking,underpinnedbyautomatic,dysphoria-perpetuating thoughts that are more catastrophic than their [patients’]actuallives,mayrespondtoacognitivebehaviouraltherapyapproach".
103
• Treatingphysician“watchingandwaiting”toseeifsymptomsresolvespontaneouslywithintwotofourweeks.
• Consultationwith or referral to a psychiatrist to “sort out complexmedication ordiagnostic considerations”, or the patient fails to respond to an adequate dose ormultipletrialsofmedications.
Table33.Listofexistingreviewsaddressingkeyclinicalquestion6
ReviewTitle ReviewAuthor Reviewtype AMSTARscore
Ageneralist'sguidetotreatingpatientswithdepressionwithanemphasisonusingsideeffectstotailorantidepressanttherapy
Bostwick2010149 Non-systematicnarrativereview
2
Theimpactofcognitivechallengesinmajordepression:theroleoftheprimarycarephysician
Mattinglyetal2016150 Non-systematicnarrativereview
1
104
Table34.GRADEEvidenceProfileTable: Inpatientswithwork-relatedmentalhealthconditionswhoarenotimproving,whatstrategiesshouldageneralpractitionerundertaketoimprovethepatient’scondition?
MHC
QualityAssessment(GRADECriteria) No.ofparticipants Effect
GRADE CommentsNo.ofstudies(n)
StudyDesign
RiskofBias
Inconsistency
Indirectness
Imprecision
OtherConsiderations
Intervention
Control
Absolute Relative
Depression
1143 RCT Notserious
none Notserious
none USstudy:primarycare
153 165 26%to32%
- HIGH Significantlyfavouredinterventions(CBTortelemedicinecollaborativecare)
Interventions:telemedicine-basedcollaborativecare(intensiveRx;on-siteprimarycareprovidersandoff-sitedepressioncaremanagers(attheR.N.level),pharmacists(atthePharm.D.level),psychologists(atthePh.D.level),andpsychiatrist)vscentre-basedcollaborativecare(on-siteprimarycareprovidersandtrainedon-sitenursedepressioncaremanagers)Outcome:Personalrecovery–Significantlygreaterresponseratesinfavouroftheinterventionatsix,12,and18months
Treatmentresistantdepression
1144 RCT Notserious
none none none UKStudy;generalpractice
206 213 24%to25%
HIGH
Interventions:12-18sessionsofcognitivebehaviouraltherapyasanadjuncttousualcarevsGPusualcarealone(antidepressantmedicationaswellascontinuedsupportandadvicefromtheGP)Outcome:Personalrecovery-Significantlygreaterresponseratesinfavouroftheinterventionatsix,and12,and18months1144 RCT Not
serious
none none none UKStudy;generalpractice
206 213 4.1to6.0
HIGH AdjustedmeandifferenceSF-12mentalsubscale
Intervention:12-18sessionsofcognitivebehaviouraltherapyasanadjuncttousualcarevs.GPusualcarealone(antidepressantmedicationaswellascontinuedsupportandadvicefromtheGP)Outcome:Personalrecovery-Reductionindepressivesymptoms(SF-12Mentalsubscale)infavourofinterventionat6and12months.
105
Depression
1145 RCT Notserious
None None None Comparedcompliancewithtwodrugs
69 68 Moderatecorrelation;-0.46(fluoxetine),-0.56(dothiepin)
Interventions:Treatmentwithfluoxetine(SSRI)vsdothiepin(tricyclicantidepressants);SSRIpresumablybettertoleratedsideeffectsOutcome:Personalrecovery(symptomsscore[Hamiltondepressionscale])–reductioninsymptomsthatsignificantlyequallycorrelatedwithcompliancewitheithermedication
Depression
1143 RCT Notserious
None Notserious
Notserious
USstudy:primarycare
150 159 9%to16%
- HIGH
Intervention:telemedicine-basedcollaborativecare(intensiveRx;on-siteprimarycareprovidersandoff-sitedepressioncaremanagers(attheR.N.level),pharmacists(atthePharm.D.level),psychologists(atthePh.D.level),andpsychiatrist)vs.centre-basedcollaborativecare(on-siteprimarycareprovidersandtrainedon-sitenursedepressioncaremanagers)Outcomes:Patientsatisfaction:Patientsatisfactionlevel(satisfiedorverysatisfied)rates-Significantlygreatersatisfactionlevelratesat6months,withnodifferenceat12months1144 RCT Not
serious
None none Notserious
Onehighqualitystudy
206 213 12.7%to24%
- HIGH
Intervention:telemedicine-basedcollaborativecare(intensiveRx;on-siteprimarycareprovidersandoff-sitedepressioncaremanagers(attheR.N.level),pharmacists(atthePharm.D.level),psychologists(atthePh.D.level),andpsychiatrist)vs.centre-basedcollaborativecare(on-siteprimarycareprovidersandtrainedon-sitenursedepressioncaremanagers)Outcome:Personalrecovery–Remission(BDI-II)rates–significantlygreaterinfavouroftheinterventionat6and12months
Depressionand/oranxiety,panicdisorder(1.6%)
3146-148
Cohort/cross-sectional
serious
serious Notserious
serious Lowmoderatequalitystudies(includes1.65withpanicdisorder
1289
- 1.19to19.80
MOD Oddsratiorange
Intervention:Non-interventionalepidemiologicalstudiesOutcomes:Poorpersonalrecovery(Factorsthatincreasedtheoddsofpoorrecovery):
• Significantlygreateroddsofpersistentdepressivesymptomsinthosefailingtoreturntoworkorhadrecurringofdisabilityatsixmonthsfollowingmusculoskeletalinjury
• Factorsidentifiedfromthosewithdepressionoranxiety(persistent,transientorgradualrecovered)vsthosewhoreportingnosymptoms)at12months(significantOR):
106
o Concurrentdepressionandanxietyo Olderage(≥70yearsold)o Comorbidpainsecondarytophysicalinjuryo Poorcopingwithpaino Femalegendero Lackofsocialsupport
• Patientreportinghighpaininterferencewerelesslikelytoachievesymptomresponse(HamiltonAnxietyRatingScale,GeneralisedAnxietyDisorderSeverityScale:ORrangefrom0.26to0.28)
107
9 Keyclinicalquestion7:ForGPswhoaremanagingpatientswithcompensationclaims,whatisappropriatecommunicationwiththepatient’sworkplace,inordertoappropriatelyinvestigateandmanageawork-relatedmentalhealthcondition?
9.1 Evidencereviewroundone
9.1.1 PICO
PGPswithpatientswhodescribework-relatedmentalhealthproblemsIAppropriatecommunicationwiththeworkplaceCGPsnotcontactingtheworkplaceOAppropriateinvestigationofawork-relatedmentalhealthcondition;Avoidance
ofissuewithemployer;Patientsatisfaction;Patientmayreturntoworkearly(ifmediationoccursearly)
9.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
1. ((Mentaladjhealth)or(Psychiatricadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*))or(Mentaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Psychologicaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Depressiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(Moodadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Affectiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Adjustmentadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Posttraumaticadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AnxietyorstressorDepressionorVicarioustrauma)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
2. ((Generaladj(practi*orphysician*ordoctor))or(Familyadj(practi*orphysician*ordoctor*))or(Familyadjmedic*adj(practi*ordoctor*))or(Primaryadjcareadj(practi*orphysician*ordoctor*))or(((Occupationalhealthadj(practi*orphysician*ordoctor*orspecialist*))orcompany)adjphysician*)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
3. ((((Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor((joborworkoremploymentortrade)adjrelated)oroccupational)adj(disease*orillness*orhealth))orCompensation)adj(claim*orcompensation)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
108
4. (Communicat**orInform*orLiais*orShar*orEducat*orcorrespond*).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
5. 1and2and3and4
9.1.3 SearchStrategy:CINAHL
# Query Limiters/Expanders
S1
“Mentalhealth”or(PsychiatricAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*))or(MentalAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(PsychologicalAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(DepressiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(MoodAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AffectiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AdjustmentAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or((“Posttraumatic”ORtraumatic)AND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))orAnxietyorstressorDepressionor“Vicarioustrauma”
Searchmodes-Boolean/Phrase
S3
(GeneralAND(practi*orphysician*ordoctor))or(FamilyAND(practi*orphysician*ordoctor*))or(Familymedic*(practi*ordoctor*))or(“Primarycare”AND(practi*orphysician*ordoctor*))or(“Occupationalhealth”AND(practi*orphysician*ordoctor*orspecialist*))or“companyphysician*”
Searchmodes-Boolean/Phrase
S4
Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor“jobrelated”or“workrelated”or“employmentrelated”or“traderelated”or“occupationaldisease*”or“occupationalillness*”or“occupationalhealth”orCompensationorclaim*
Searchmodes-Boolean/Phrase
S9Communicat*ORInform*ORLiais*ORShar*ORcorrespond*ORDisclos*ORReport*
Searchmodes-Boolean/Phrase
S29 S1ANDS3ANDS4ANDS9Searchmodes-Boolean/Phrase
S30 S1ANDS3ANDS4ANDS9
Limiters-EnglishLanguage;AgeGroups:Adolescence,13-18years,Adult,19-44years,MiddleAge,45-64years,Aged,65+years,Aged,80andover
109
Searchmodes-Boolean/Phrase
9.1.4 Searchperiod
Databaseinceptiontothe31stofJanuary2017.
9.1.5 PRISMAroundone
Embase,Medline,PsycINFOandAMEDreturnedn=4recordsandCINAHLreturnedn=1295records.
Figure26.RoundonePRISMAchartforkeyclinicalquestion7
9.2 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting
- ReviseKeyclinicalquestion7toread:“Whatisappropriatecommunicationwiththepatient’sworkplace,inordertoappropriatelymanageawork-relatedmentalhealthcondition?”
- RemoveGPfocusfromsearchstrategyinclusioncriteria.
- Expandsearchstrategytoincluderelevantexistingclinicalguidelinesandsystematicreviews.
110
9.3 Evidencereviewroundtwo
9.3.1 PICO
PWorkerswithamentalhealthclaimIAppropriatecommunicationwithaworkplaceCInappropriatecommunicationwithaworkplaceOAppropriatemanagement
9.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
Nochangetosearchstrategy
9.3.3 SearchStrategy:CINAHL
Nochangetosearchstrategy
9.3.4 Searchperiod
Fromthe1stofFebruary2017tothe30thofApril2017
9.3.5 PRISMAround2
Embase,Medline,PsycINFOandAMEDreturnedn=4recordsandCINAHLreturnedn=35records.
111
Figure27.RoundtwoPRISMAchartofkeyclinicalquestion7updates
112
Figure28.CombinedroundoneandroundtwoPRISMAchartforkeyclinicalquestion7
9.4 ExistingGuidelinesandSystematicReviewsforKeyclinicalquestion7
9.4.1 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting
- ReviseKeyclinicalquestion7toread:“Whatisappropriatecommunicationwiththepatient’sworkplace,inordertoappropriatelymanageawork-relatedmentalhealthcondition?”
- RemoveGPfocusfromsearchstrategyinclusioncriteria.
- Expandsearchstrategytoincluderelevantexistingclinicalguidelinesandsystematicreviews.
9.4.2 PICO
PWorkerswithamentalhealthclaimIAppropriatecommunicationwithaworkplaceCInappropriatecommunicationwithaworkplaceOAppropriatemanagement
113
9.4.3 Guidelines
9.4.3.1 SearchStrategy
Table35.Searchstrategyforexistingguidelinesforkeyclinicalquestion7
GuidelineResource SearchstrategyandLimitersGINMentalDisorders(Meshterms),EnglishNationalGuidelineClearinghouse
Work
NHMRC ListreviewCentreforReviewsandDisseminationHealthTechnologyAssessmentDatabase
Returntowork
RACGP ListreviewRANZCP ListreviewNICE/Mentalhealthandbehaviouralconditions ListReviewNICE/Injuries,accidentsandwounds ListReviewNICE Work(keyword)SIGN Listreview
• WHO/Chronicdiseases,injuriesanddisability Listreview• WHO/non-communicablediseasesandrisk
factorsListreview
• WHO/Mentalhealthandsubstanceabuse ListreviewPubMed workANDpsychosocialANDguidelineGoogle workANDdepressionANDguideline
work-relatedANDpsychologicalANDguidelineworkANDadjustmentdisordersANDguidelineworkANDstressANDguidelinework-relatedANDmentalhealthANDguidelinework-relatedANDmentalhealthANDreview
9.4.3.2 Searchperiod
Originalsearch:uptothe29thofMay2017.
114
9.4.3.3 PRISMA-Guidelines
Figure29.PRISMAchartofguidelinesforkeyclinicalquestion7
Table36.Guidelineswithrecommendationsaddressingkeyclinicalkeyclinicalquestion7
ReviewTitle Author Date AGREEBestpracticesforreturn-to-work/stay-at-workinterventionsforworkerswithmentalhealthconditions151
Pomakietal.,OccupationalHealthandSafetyAgencyforHealthcareinBritishColumbia
2010 67%
9.4.4 Systematicreviews
Table37.Searchstrategyforexistingsystematicreviewsforkeyclinicalquestion7
SystematicReviewResource SearchStrategyandLimitersCampbellCollaborationLibrary ListreviewCampbellCollaborationLibrary Work(keyword)CochraneLibrary [[Mentalorpsychologicalorpsychiatricor
stressordistressordepressormoodoraffectiveoradjustmentortraumaticoranxiety]AND[employerOR"occupation"ORjobORvocationORcompensateORworkplace]AND[communicateORinformationORshareOR
115
liaiseORcorrespond]]RESTRICTbyCochranereviews
CochraneReviews workANDmentalhealthANDguidelineworkandmentalhealthreturntoworkwork-related
CochraneReviews/topichealthandsafetyatwork
Listreview
CochraneReviews/“Work”reviewgroup ListreviewCochraneReviews/Commonmentaldisorders ListreviewCochraneReviews/”Injuries”reviewgroup ListreviewCochraneWork>OurEvidence>Occupationalhealthoutcome
Listreview
CentreforReviewsandDisseminationHealthTechnologyAssessmentDatabase
returntoworkwork-relatedANDmentalhealthANDreviewworkANDpsychologicalANDreviewworkANDdepressionANDreview
PubMed workANDmentalillnessANDreviewGoogle workANDpsychologicalANDguideline
workANDPTSDANDreviewwork-relatedANDpsychologicalANDreviewworkANDdepressionANDreview
9.4.4.1 Searchperiod
Originalsearch:uptothe29thofMay2017
116
9.4.4.2 PRISMA-Systematicreviews
Figure30.PRISMAchartofsystematicreviewsforkeyclinicalquestion7
9.5 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion7
Table38.Keyclinicalquestion7literaturesearchresultsandimplicationsarisingfromsearchstringsusedinrelationtowork
EvidenceReviewRounds
Originalkeyclinicalquestion7.ForGPswhoaremanagingpatientswithcompensationclaims,whatisappropriatecommunicationwiththepatient’sworkplace,inordertoappropriatelyinvestigateandmanageawork-relatedmentalhealthcondition?
Ovidimplication CINAHLimplication
OVIDcount
CINAHLcount
R1 - Mentalhealthconditions(includedvicarioustrauma)
- Generalpractice- Work-relatedness- Communication
Workinthecompensablesetting
work 4
1295
117
R2 RevisedKeyclinicalquestion7.Whatisappropriatecommunicationwiththepatient’sworkplace,inordertoappropriatelymanageawork-relatedmentalhealthcondition?- Mentalhealthconditions(included
vicarioustrauma)- Generalpractice- Work-relatedness- Communication- Feb–April2017
Workinthecompensablesetting
work 4
35
Ifwork-relatednesssearchstringhadbeencorrectedto“work”
Work 110 Noimpact
Searchforguidelinesandsystematicreviews
Guidelinesn=54Systematicreviewsn=32
EvidenceReviewGroupRecommendation:Forkeyclinicalquestion7thereviewshouldconsiderthe110hitsinOvidthatwouldhaveoccurredasaresultofthesearchstringerrorcorrectioninround2inordertoinformthefinalguidelinerecommendationoftheGuidelineDevelopmentGroup.Followingtheaboverecommendation,anupdatedsearchwasperformedforkeyclinicalquestion7andnonewstudieswereidentifiedforinclusionasshowninFigure31.
118
Figure31.Searchoutcomeforkeyclinicalquestion7followingevidencereviewrecommendations
9.6 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:Keyclinicalquestion7
Twostudies152153(Table39)andoneexisting2010practiceguideline/report(AGREE-IIscore75%)151wereincludedforthiskeyclinicalquestion.Thetwostudiesprovidedaqualitativeevidence narrative on work-related stress and depression. One explored collaborationbetweenoccupational health services and theworkplace 152 and theotherdescribedGPs’practiceswith dealingwithwork-related depressive disorders 153. Three key themeswereidentified pertaining to 1) communication content; 2) issues around patient/workerprivacy/confidentiality, and; 3) the key stakeholders involved in the communicationconcerningworkplacehealthmatters.
119
Table39.DownsandBlackChecklistqualityassessmentscoresforstudiesincludedinkeyclinicalquestion7
Reporting(Overallstudyquality)
Externalvalidity
Internalvalidity(Studybias)
Internalvalidity(Confoundingandselectionbias)
Powerofstudy
Total
Kinnunen-Amoroso&Liira2016152 6.0 2.0 4.0 2.5 0 14.5Sylvianetal2015153 6.0 2.0 3.5 3.0 0 14.5
Mean 6.0 2.0 3.8 2.8 0 14.5SD 0 0 0.4 0.4 0 0
120
Table40.GRADEEvidenceProfileTable:Whatisappropriatecommunicationwiththepatient’sworkplaceinordertoappropriatelymanageawork-relatedmentalhealthcondition?
QualityAssessment(GRADECriteria) No.ofparticipants
Effect
GRADE CommentsMHC No.ofstudies
StudyDesign
RiskofBias
Inconsistency
Indirectness
Imprecision
OtherConsiderations
Absolute Relative
Stress,Depression
1152153 Cross-sectional
Serious Notserious
Notserious
none Lowqualitystudies;FinnishandCanadiancontexts
226 N/A N/A LOW -
Interventions:N/AOutcome:Appropriatecommunicationwiththeworkplace–(information/content,principle,stakeholders):
• Content/Informationtobecommunicatedbetweenpractitionersandtheworkplaceo Clearcommunicationfromthepractitionertotheworkplaceaboutwhatworkplaceadjustmentsmaybeneededtomitigatework-related
stressandfacilitatereturntoworko “TheOPsalonecan'tchangetheworkingconditionsandtheenterprisesneedmoreadequateinformationfromOHS[occupationalhealth
services–occupationalphysiciansandpsychologists]whatthey[enterprise/workplace]cando…”tobettermanagework-relatedstress• Principlestoobservepractitioner/patient/workerprivacy/confidentialityincommunication
o Somereservationsaboutcommunicatingwiththeworkplaceandwhethercommunicationisrelevant,"Informationisneverexchangeddirectlywithemployers,mostlytopreserveconfidentialityofinformation,andisnotevenseenasrelevant"
o Thus,communicationwiththirdpartiesneedstoobservepatient(worker)privacyandconfidentialityandthisisbalancedagainstthepractitioner’sneedforinformationtoclarifytheworksituationforthepurposeofformulatingareturntoworkplan
o TheneedforbalancedGPengagementwiththeworkplacetoinformandenabletheGPtomake"...validjudgmentabouttheperson’sabilitytoreturntowork"balancedagainstprivacyandconfidentialityprotections
• Communicationkeystakeholderso Healthpractitionerandoccupationalsafetyrepresentative,humanresourcemanager,supervisorsandenterpriseadministrationsarethekey
partnersincommunicationconcerninganinjuredworker
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10 Keyclinicalquestion8:Whenconveyingadiagnosisofawork-relatedmentalhealthconditiontoapatient,whatfactorsshouldGPsconsider,toensurethattheirdiagnosisisunderstoodandacknowledgedbythepatient?
10.1 Evidencereviewroundone
10.1.1 PICO
PPatientsdiagnosedwithawork-relatedmentalhealthconditionIFactorsthatmustbeconsideredpriortocommunicatingadiagnosisCNon-specificfactorsOPatientoutcomestobedefined.Clearcommunication;accurateunderstanding
ofthediagnosis;Managementofpatientexpectationsregardingrecovery
10.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
1. ((Mentaladjhealth)or(Psychiatricadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*))or(Mentaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Psychologicaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Depressiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(Moodadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Affectiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Adjustmentadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Posttraumaticadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AnxietyorstressorDepressionorVicarioustrauma)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
2. ((((Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor((joborworkoremploymentortrade)adjrelated)oroccupational)adj(disease*orillness*orhealth))orCompensation)adj(claim*orcompensation)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
3. ((Patientadj(AwarenessorKnowledgeorunderstandingorcomprehension))or(Healthadjliteracy)orPatienteducationorPhysician-patientrelation*).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
4. (Patientand(Communicati*orInformingoreducat*orSharingor(patient*adj(Communicati*oreducation)))).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
5. 3or4
122
6. 1and2and5
10.1.3 SearchStrategy:CINAHL
# Query Limiters/Expanders
S1
“Mentalhealth”or(PsychiatricAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*))or(MentalAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(PsychologicalAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(DepressiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(MoodAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AffectiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AdjustmentAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or((“Posttraumatic”ORtraumatic)AND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))orAnxietyorstressorDepressionor“Vicarioustrauma”
Searchmodes-Boolean/Phrase
S4
Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor“jobrelated”or“workrelated”or“employmentrelated”or“traderelated”or“occupationaldisease*”or“occupationalillness*”or“occupationalhealth”orCompensationorclaim*
Searchmodes-Boolean/Phrase
S10(PatientAND(AwarenessorKnowledgeorunderstandingorcomprehension))or“Healthliteracy”or“Patienteducation”or“Physician-patientrelation*”
Searchmodes-Boolean/Phrase
S11(PatientAND(Communicati*ORInformingOReducat*))ORSharingORCommunicati*OReducation
Searchmodes-Boolean/Phrase
S31 S10ORS11Searchmodes-Boolean/Phrase
S32 S1ANDS4ANDS31Searchmodes-Boolean/Phrase
S33 S3ANDS32
Limiters-EnglishLanguage;AgeGroups:Adolescence,13-18years,Adult,19-44years,MiddleAge,45-64years,Aged,65+years,Aged,80andoverSearchmodes-Boolean/Phrase
123
10.1.4 Searchperiod
Databaseinceptiontothe31stofJanuary2017.
10.1.5 PRISMAround1
Embase,Medline,PsycINFOandAMEDreturnedn=7recordsandCINAHLreturnedn=951records.
Figure32.RoundonePRISMAchartforkeyclinicalquestion8
10.2 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting
- Removework-relatednessfromsearchinclusioncriteria
- RemoveGPfocusfromsearchinclusioncriteria
- Betterdefineoutcomemeasures(basedonanalysisofexistingguidelines).Includeterminologysuchaspatientperceptions,patientsatisfactionandacceptance.
- Reviewexistinghigh-qualityguidelinesoninformationpertainingtocommunication.NICEguidelineprovidesrecommendationsregardingthecommunicationofamentalhealthcondition.RefertoExperiencedCareChapter.
- UndertakeanAGREEassessmentonexistingguidelinesthataredrawnupon.
124
10.3 Evidencereviewroundtwo
10.3.1 PICO
PPatientswithawork-relatedmentalhealthconditionIFactorstoconsiderCFactorstoconsiderOPatientunderstandingand/oracknowledgementofadiagnosis
10.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
Nochangetosearchstrategy.However,updatedsearchwasnotperformedfollowingdecisiontorelyonexistingclinicalpracticeguidelines.
10.3.3 SearchStrategy:CINAHL
Nochangetosearchstrategy.However,updatedsearchwasnotperformedfollowingdecisiontorelyonexistingclinicalpracticeguidelines.
10.3.4 Searchperiod
Updatedsearchwasnotperformedfollowingdecisiontorelyonexistingclinicalpracticeguidelines.
10.3.5 PRISMAround2
Seeabovenote(searchperiod).
10.4 ExistingGuidelinesandSystematicReviewsforKeyclinicalquestion8
10.4.1 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting
- Removework-relatednessfromsearchinclusioncriteria
- RemoveGPfocusfromsearchinclusioncriteria
- Betterdefineoutcomemeasures(basedonanalysisofexistingguidelines).Includeterminologysuchaspatientperceptions,patientsatisfactionandacceptance.
- Reviewexistinghigh-qualityguidelinesoninformationpertainingtocommunication.NICEguidelineprovidesrecommendationsregardingthecommunicationofamentalhealthcondition.RefertoExperiencedCareChapter.
- UndertakeanAGREEassessmentonexistingguidelinesthataredrawnupon
10.4.2 PICO
PPatientswithawork-relatedmentalhealthconditionIFactorstoconsiderCFactorstoconsiderOPatientunderstandingand/oracknowledgementofadiagnosis
125
10.4.3 Guidelines
10.4.3.1 SearchStrategy
Table41.Searchstrategyforexistingguidelinesforkeyclinicalquestion8
GuidelineResource SearchstrategyandLimitersGINMentalhealth(Meshterms)English,NationalGuidelineClearinghouse/psychology
Listreview
NationalGuidelineClearinghouse/psychiatric ListreviewNationalGuidelineClearinghouse ListreviewNHMRCClinicalGuidelinesPortal ListreviewNHMRCClinicalGuidelinesPortal mentalhealth(keyword)
anxiety(keyword)post-traumaticstressdisorder(keyword)
MinistryofHealth,socialservicesandequality(Spain)
Listreview
NICE/Mentalhealthandbehaviouralconditions ListreviewNICE/PosttraumaticstressdisorderListreview ListreviewRACGP ListreviewSIGN/MentalHealth MentalhealthRANZCP ListreviewWHO ListreviewWHO/Mentalhealthandsubstanceabuse ListreviewGoogle workANDmentalhealthANDguideline
anxietyguidelineswork-relatedANDmentalillnessANDguidelineworkANDadjustmentdisordersANDguidelineDepressionguideline
10.4.3.2 Searchperiod
Originalsearch:uptothe29thofMay2017.
126
10.4.3.3 PRISMA–Guidelines
Figure33.PRISMAchartofguidelinesforkeyclinicalquestion8
Table42.Guidelineswithrecommendationsaddressingkeyclinicalquestion8
GuidelineTitle GuidelineAuthor Date AGREEscore
Depression:TheNICEguidelineonthetreatmentandmanagementofdepressioninadults13
NICE 2016 92%
Adultdepressioninprimarycare.Bloomington(MN):InstituteforClinicalSystemsImprovement(ICSI)74
Trangleetal.:InstituteforClinicalSystemsImprovement
2016 67%
Depressioninadultswithachronicphysicalhealthproblem:recognitionandmanagement12
NICE 2009(updated2015)
100%
Depressioninchildrenandyoungpeople:identificationandmanagementinprimary,communityandsecondarycare154
NICE 2005(updated2015)
92%
Diagnosisandtreatmentofpost-traumaticstressdisorderinemergencyserviceworkers98
Harveyetal.:BlackDogInstitute,TheUniversityofNewSouthWales
2015 73%
Clinicalpracticeguidelinesforthemanagementofrotatorcuffsyndromein
Hopmanetal.:TheUniversityofNewSouth
2013 83%
127
GuidelineTitle GuidelineAuthor Date AGREEscore
theworkplace99 WalesGeneralisedanxietydisorderandpanicdisorderinadults(CG113)16
NICE 2011 83%
Practiceguidelineforthetreatmentofpatientswithpanicdisorder2ndedition79
AmericanPsychiatricAssociation
2010 67%
Clinicalpracticeguidelineformanagementofpost-traumaticstress78
DepartmentofVeteransAffairs(VaDoD)
2010 67%
10.4.4 Systematicreviews
Table43.Searchstrategyforexistingsystematicreviewsforkeyclinicalquestion8
SystematicReviewResource SearchStrategyandLimitersCampbellCollaborationLibrary ListreviewCochrane [[Mentalorpsychologicalorpsychiatricor
stressordistressordepressormoodoraffectiveoradjustmentortraumaticoranxiety]AND[employerOR"occupation"ORjobORvocationORcompensateORworkplace]AND[communicateORinformationORshareORliaiseORcorrespond]]RESTRICTbyCochranereviews[Mentalorpsychologicalorpsychiatricorstressordistressordepressormoodoraffectiveoradjustmentortraumaticoranxiet]AND["Physician"orgeneralpractitionerordoctororfamilyphysicianorfamilydoctororpsychiatristorpsychologistoroccupationalphysicianoroccupationalspecialist]AND[diagnosis]and[["patientawareness"or"patientknowledge"or"patientunderstanding"or"patientcomprehension"or"patientacceptance"or"patienteducation"]OR[communicationorinformationorsharing]]workandmentalhealth
CochraneReviews/topichealthandsafetyatwork
Listreview
CochraneReviews/topicmentalhealth ListreviewCochraneReviews/“Work”reviewgroup ListreviewCochraneReviews/Commonmentaldisordersreviewgroup
Listreview
CochraneReviews/”Injuries”reviewgroup ListreviewCentreforReviewsandDisseminationHealth work-relatedANDmentalhealthANDreview
128
TechnologyAssessmentDatabase
10.4.4.1 Searchperiod
Originalsearch:uptothe29thofMay2017.
10.4.4.2 PRISMA-Systematicreviews
Figure34.PRISMAchartofsystematicreviewsforkeyclinicalquestion8
129
10.5 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion8
Table44.Keyclinicalquestion8literaturesearchresultsandimplicationsarisingfromsearchstringsusedinrelationtowork
EvidenceReviewRounds
Originalkeyclinicalquestion8.Whenconveyingadiagnosisofawork-relatedmentalhealthconditiontoapatient,whatfactorsshouldaGPconsidertoensurethattheirdiagnosisisunderstoodandacknowledgedbythepatient?
Ovidimplication CINAHLimplication
OVIDcount
CINAHLcount
R1 - Mentalhealthconditions(includedvicarioustrauma)
- Generalpractice- Work-relatedness- Patientunderstanding- Conveyingdiagnosis
Workinthecompensablesetting
Work 7
951
Ifwork-relatednesssearchstringhadbeencorrectedto“work”
Work 25082
R2 Nochangetokeyclinicalquestionmade.Nodatabasesearchedweresecondarytodecisiontouseguidelinesandsystematicreviewsonly
N/A N/A N/A N/A
N/A N/A N/A N/A
Searchforguidelinesandsystematicreviews
Guidelinesn=70Systematicreviewsn=3
N/A–Roundtwodatabasesearcheswerenotperformedforthiskeyclinicalquestionfollowingthedecisiontouseguidelinesandsystematicreviewsonly.
EvidenceReviewGroupRecommendation:Forkeyclinicalquestion8thelargenumberofhitsinOvidthatwouldhaveoccurredasaresultofthesearchstringerrorcorrectionwouldhavemadethesearchunfeasible.OurrecommendationistoacceptthefinalrecommendationasperGuidelineDevelopmentGroupmeeting3.
10.6 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:Keyclinicalquestion8
The roundone search returnedno relevant studies thatmet the inclusioncriteria for keyclinical question 8 and as such a GRADE evidence table of primary studies was notapplicable. Instead, evidence review for round two focussed on a targeted search forexistingclinicalpracticeguidelinesandsystematicreviewsonly.
130
The guidelines meeting the scope for key clinical question 8 and had explicit relevantrecommendationsarepresentedinTable45.
Table45.Listofexistingpracticeguidelinesaddressingkeyclinicalquestion8
GuidelineTitle GuidelineAuthor/Publisher Date AGREE-IIScore
Depression:TheNICEguidelineonthetreatmentandmanagementofdepressioninadults13
NICE 2016 92%
Adultdepressioninprimarycare.Bloomington(MN):InstituteforClinicalSystemsImprovement(ICSI)74
Trangleetal.:InstituteforClinicalSystemsImprovement
2016 67%
Depressioninadultswithachronicphysicalhealthproblem:recognitionandmanagement12
NICE 2015 100%
Depressioninchildrenandyoungpeople:identificationandmanagementinprimary,communityandsecondarycare154
NICE 2015 92%
Diagnosisandtreatmentofpost-traumaticstressdisorderinemergencyserviceworkers98
BlackDogInstitute,TheUniversityofNewSouthWales
2015 73%
Clinicalpracticeguidelinesforthemanagementofrotatorcuffsyndromeintheworkplace99
TheUniversityofNewSouthWales
2013 83%
Generalisedanxietydisorderandpanicdisorderinadults(CG113)16
NICE 2011 83%
Practiceguidelineforthetreatmentofpatientswithpanicdisorder2ndedition79
AmericanPsychiatricAssociation(APA)
2010 67%
Clinicalpracticeguidelineformanagementofpost-traumaticstress78
DepartmentofVeteransAffairs(VaDoD)
2010 67%
Weidentifiedandgroupedrelevantrecommendationsintofourthemesaround,i)generalprinciplesinvolvedindiagnosisthatimpactonapatient’sunderstanding;ii)thevalueofestablishingatherapeuticalliance;iii)informationtofacilitateapatient’sunderstandingandacknowledgementoftheirdiagnosis,and;iv)thecontentandtypeofthisinformation
Generalprinciplesinvolvedindiagnosisthatimpactonapatient’sunderstanding
The NICE 2016 guidelines offered a number of consensus-based recommendationsregardingprinciplestoconsiderwhendiagnosingapatientwithdepression.Theseinclude:
• Berespectfulofandsensitivetodiversebackgrounds• Buildatrustingrelationshipandworkinanopen,engagingandnon-judgemental
manner• be aware that stigmaanddiscrimination canbe associatedwith a diagnosis of
depression13(consensus)• Negotiatingbetween thepersonand their familyor carerabout confidentiality
andthesharingofinformation13(consensus)
131
Thevalueofestablishingatherapeuticalliance
Two guidelines discussed the value of establishing a therapeutic alliance 74 79. Bothguidelines were based on low evidence, however the recommendation was labelled asstrong.Thisincludes:
• Beforeinitiatingtreatment,itisimportanttoestablishatherapeuticalliancewiththepatientregardingdiagnosisandtreatmentoptions(inwhichthereisoverlapinthepatient'sandclinician'sdefinitionoftheproblemandagreementonwhichstepsaretobetakenbyeach)69(STRONG)
• Psychiatristsshouldworktoestablishandmaintainatherapeuticalliancesothatthepatient’scareisacollaborativeendeavour74(Recommendedwithsubstantialclinicalconfidence)
Informationtofacilitateapatient’sunderstandingandacknowledgementoftheirdiagnosis?
Anumberofguidelines121316799899providedguidanceaboutthetypeof informationthatshouldbegiventopatients.Theseincluded:
• Provide information about the nature and course of depression and range oftreatmentsavailable13(consensus)
• Advisepatients tobevigilant formoodchanges,negativityandhopelessness12(consensus)
• Provide psycho-education around physical injuries that may lead to mentalhealthsymptoms99(consensus)
• Provideeducationaboutpanicdisorderanditstreatment79(STRONGFOR)• Treatmentsavailable:
o Explore treatment options in an atmosphere of hope and optimism,explaining the different courses of depression and that recovery ispossible13(consensus)
o Treatmentgoals98(consensus);o Potentialforsideeffectsoftreatments1216(consensus)
Type of information and content to consider when offering an information package to apatient
AnumberofNICEguidelinesandtheAPA2010guidelinesprovidedguidanceaboutthetypeofinformationthatshouldbegiventopatients.Theseincluded:
• Language that is readily understandable to the patient: STRONG FOR 79,consensus13
• Provideinformationappropriatetotheirlevelofunderstandingaboutthenatureofdepressionandtherangeoftreatmentsavailable154
• Avoidclinicallanguagewithoutadequateexplanation13(consensus).• Provide andwork proficientlywith independent interpreters (that is, someone
whoisnotknowntothepersonwithdepression)ifneeded13(consensus).
132
11 Keyclinicalquestion9:Inpatientswithwork-relatedmentalhealthconditions,whatinterventionsareeffectiveatmanagingcomorbidsubstancemisuseandaddictivedisordersbyGPs?
11.1 Evidencereviewroundone 11.1.1 PICO
PPatientswithcomorbiditiesIInterventionstomanagementalhealthcomorbidities(specificallyrelatedand
addictivedisorders)CComparebetweeninterventionsOEvidence-basedmanagementofcomorbidities
11.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
1. ((Mentaladjhealth)or(Psychiatricadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*))or(Mentaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Psychologicaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Depressiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(Moodadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Affectiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Adjustmentadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Posttraumaticadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AnxietyorstressorDepressionorVicarioustrauma)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]]
2. ((Generaladj(practi*orphysician*ordoctor))or(Familyadj(practi*orphysician*ordoctor*))or(Familyadjmedic*adj(practi*ordoctor*))or(Primaryadjcareadj(practi*orphysician*ordoctor*))or(((Occupationalhealthadj(practi*orphysician*ordoctor*orspecialist*))orcompany)adjphysician*)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
3. ((((Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor((joborworkoremploymentortrade)adjrelated)oroccupational)adj(disease*orillness*orhealth))orCompensation)adj(claim*orcompensation)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
4. (Strateg*orIntervention*orTreatment*orCare*ormanag*orapproach*ordecision*oraction*orTherap*orrefer*).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
133
5. ((Otheradj(illness*ordisorder*orcondition*))orcomorbidsubstanceabuse*orsubstanceabuse*orcomorbiddruguse*orcomorbidit*orprescriptiondrugmisuse*orsubstance-relateddisorder*or(addicti*adjdisorder*)oraddition).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
6. 1and2and3and4and5[NB.returned0hits]7. 1and2and4and5[returnedresults(2065)whenwork(3)wasexcluded]
11.1.3 SearchStrategy:CINAHL
# Query Limiters/Expanders
S1
“Mentalhealth”or(PsychiatricAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*))or(MentalAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(PsychologicalAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(DepressiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(MoodAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AffectiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AdjustmentAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or((“Posttraumatic”ORtraumatic)AND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))orAnxietyorstressorDepressionor“Vicarioustrauma”
Searchmodes-Boolean/Phrase
S3
(GeneralAND(practi*orphysician*ordoctor))or(FamilyAND(practi*orphysician*ordoctor*))or(Familymedic*(practi*ordoctor*))or(“Primarycare”AND(practi*orphysician*ordoctor*))or(“Occupationalhealth”AND(practi*orphysician*ordoctor*orspecialist*))or“companyphysician*”
Searchmodes-Boolean/Phrase
S4
Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor“jobrelated”or“workrelated”or“employmentrelated”or“traderelated”or“occupationaldisease*”or“occupationalillness*”or“occupationalhealth”orCompensationorclaim*
Searchmodes-Boolean/Phrase
S5Strateg*orIntervention*orTreatment*orCare*ormanag*orapproach*ordecision*oraction*orTherap*orrefer*
Searchmodes-Boolean/Phrase
S12
“Otherillness*”OR“otherdisorder*”OR“othercondition*”OR“comorbidsubstanceabuse*”OR“substanceabuse*”OR“comorbiddruguse*”ORcomorbidit*OR“prescriptiondrugmisuse*”OR“substance-relateddisorder*”OR“substanceaddicti*”OR“substancerelateddisorder*”ORaddict*OR
Searchmodes-Boolean/Phrase
134
“alcoholabuse”
S34 S1ANDS3ANDS4ANDS5ANDS12Searchmodes-Boolean/Phrase
11.1.4 Searchperiod
Databaseinceptiontothe31sttheJanuary2017.
11.1.5 PRISMAround1
Embase,Medline,PsycINFOandAMEDreturnedn=2065recordsandCINAHLreturnedn=403records.
Figure35.RoundonePRISMAchartforkeyclinicalquestion9
135
11.2 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting
- Removework-relatednessfocusfromsearchinclusioncriteria
- RemoveGPaspectfromsearchinclusioncriteria
- Supplementthefindingsofthesearchforexistingsystematicreviewsandguidelinesonthemanagementofmentalhealthconditionsandcomorbidsubstanceabuse(e.g.PTSDguidelines).
11.3 Evidencereviewroundtwo11.3.1 PICO
PPatientswithawork-relatedmentalhealthconditionIInterventionsformanagingcomorbidsubstancemisuseandaddictivedisordersCAllinterventionsformanagingcomorbidsubstancemisuseandaddictive
disordersOEffectivemanagement
11.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
Nochangetosearchstrategy
11.3.3 SearchStrategy:CINAHL
Nochangetosearchstrategy
11.3.4 Searchperiod
Fromthe1stofFebruary2017tothe30thofApril2017.
11.3.5 PRISMAround2
Embase,Medline,PsycINFOandAMEDreturnedn=92recordsandCINAHLreturnedn=12records.
136
Figure36.RoundtwoPRISMAchartofkeyclinicalquestion9updates
137
Figure37.CombinedroundoneandroundtwoPRISMAforkeyclinicalquestion9
11.4 ExistingGuidelinesandSystematicReviewsforKeyclinicalquestion9
11.4.1 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting
- Removework-relatednessfocusfromsearchinclusioncriteria
- RemoveGPaspectfromsearchinclusioncriteria
- Supplementthefindingsofthesearchforexistingsystematicreviewsandguidelinesonthemanagementofmentalhealthconditionsandcomorbidsubstanceabuse(e.g.PTSDguidelines).
11.4.2 PICO
PPatientswithawork-relatedmentalhealthconditionIInterventionsformanagingcomorbidsubstancemisuseandaddictivedisordersCAllinterventionsformanagingcomorbidsubstancemisuseandaddictive
disordersOEffectivemanagement
138
11.4.3 Guidelines
Table46.Searchstrategyforexistingguidelinesforkeyclinicalquestion9
GuidelineResource SearchstrategyandLimitersGIN MentalDisorders(Meshterms),EnglishNationalGuidelineClearinghouse(NGC)/psychiatry
Listreview
NationalGuidelineClearinghouse/psychology ListReviewNHMRCClinicalguidelinesportal ListreviewRACGP ListreviewRANZCP ListreviewNICE/Mentalhealthandbehaviouralconditions ListreviewNICE/Mentalhealthandbehaviouralconditions/alcohol
Listreview
SIGN ListreviewSIGN Mentalhealth(keyword)WHO ListreviewGoogle workANDadjustmentdisordersANDguideline
11.4.3.1 Searchperiod
Uptothe25thofMay2017
11.4.3.2 PRISMA–Guidelines Six existing practice guidelines were identified to meet the scope and outcomes for keyclinical question 9 (Figure 38). An additional seventh guideline 73 was identified throughguideline review of other key clinical questions and included. The guidelines and theirqualityscoresarepresentedinTable47.
139
Figure38.PRISMAchartofguidelinesforkeyclinicalquestion9
Table47.Guidelineswithrecommendationsaddressingkeyclinicalquestion9
GuidelineTitle GuidelineAuthor Date AGREE-IIscore
Clinicalpracticeguidelineforthemanagementofsubstanceusedisorders66
DepartmentofVeteran'sAffairs
2015 83%
Generalisedanxietydisorderandpanicdisorderinadults(CG113)16
NICE 2011 83%
Alcohol-usedisorders:diagnosis,assessmentandmanagementofharmfuldrinkingandalcoholdependence(CG115)15
NICE 2011(Updated2015)
90%
Drugmisuseinover16s:opioiddetoxification(CG52)155
NICE 2007(Updated2014)
83%
DiagnosisandTreatmentofPost-traumaticStressDisorderinEmergencyServiceWorkers98
Harveyetal.:BlackDogInstitute,TheUniversityofNewSouthWales
2015 73%
Prescribingdrugsofdependenceingeneralpractice156
RACGP 2015 67%
Australianguidelinesforthetreatmentofacutestressdisorderandpost-traumaticstressdisorder73
PhoenixAustralia 2013 75%
140
11.4.4 Systematicreviews
Table48.Searchstrategyforexistingsystematicreviewsforkeyclinicalquestion9
SystematicReviewResource SearchStrategyandLimitersCampbellCollaboration ListreviewCochrane [[Mentalorpsychologicalorpsychiatricor
stressordistressordepressormoodoraffectiveoradjustmentortraumaticoranxiety]AND[substancemisuseorsubstanceabuseordrugoralcoholoraddictoraddiction]AND[comorbidorco-morbid]RESTRICTEDtoCochranereviews
CochraneReviews/Commonmentaldisordersreviewgroup
Listreview
CochraneReviews/topicmentalhealth ListreviewJoannaBriggsInstitute Mentalhealth-Listreview
11.4.4.1 Searchperiod
Uptothe25thofMay2017.
141
11.4.4.2 PRISMA-Systematicreviews
Figure39.PRISMAflowchartofsystematicreviewsforkeyclinicalquestion9
Table49.Systematicreviewswithfindingsaddressingkeyclinicalquestion9
ReviewTitle ReviewAuthor Date AMSTARscore(?/11)
Reviewtype
Psychologicaltherapiesforpost-traumaticstressdisorderandcomorbidsubstanceusedisorder157
Robertsetal 2016 10 Cochranereview
Pharmacotherapyforanxietyandcomorbidalcoholusedisorders158
Ipseretal 2015 11 Cochranereview
142
11.5 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion9
Table50.Keyclinicalquestion9literaturesearchresultsandimplicationsarisingfromsearchstringsusedinrelationtowork
EvidenceReviewRounds
Originalkeyclinicalquestion9.Inpatientswithwork-relatedmentalhealthconditions,whatinterventionsareeffectiveatmanagingcomorbidsubstancemisuseandaddictivedisordersbyGPs?
Ovidimplication CINAHLimplication
OVIDcount
CINAHLcount
R1 - Mentalhealthconditions(includedvicarioustrauma)
- Generalpractice- Work-relatedness- Comorbidsubstanceuse- Strategies
Workincompensablesetting
Work 0 403
Excludedworkincompensablesetting
work 2065
403
Ifwork-relatednesssearchstringhadbeencorrectedto“work”
Work 1263 Noimpact
R2 Nochangemadetokeyclinicalquestion.- Mentalhealthconditions
(includedvicarioustrauma)- Generalpractice- Work-relatedness- Comorbidsubstanceuse- Strategies- Feb–April2017
Excludedworkincompensablesetting
Work 92 12
Ifwork-relatednesssearchstringhadbeencorrectedto“work”
Work 29 Noimpact
Searchforguidelinesandsystematicreviews
Guidelinesn=17Systematicreviewsn=10
EvidenceReviewGroupRecommendation:Nochangeforkeyclinicalquestion9becausethesearchwithout“work”wasbroader.”OurrecommendationistoacceptthefinalrecommendationasperGuidelineDevelopmentGroupmeeting3
143
11.6 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:Keyclinicalquestion9
Onlyonehigh-qualitystudy(Table51)lookingatanalcoholreductiondirectedinterventionofcounsellinginpatientwithcomorbidanxietyand/ordepressionmettheinclusioncriteria.The intervention was associated with reduced alcohol consumption among those withcomorbid anxiety and/or depression; this was not significant in contrast to a significantreductioninthosewithoutcomorbidanxietyand/ordepression.
TwoexistinghighqualityCochranesystematicreviews(Table52)meetingthescopeforthiskey clinical question were identified. The first review 157 explored the efficacy ofpsychologicaltherapiesinpeoplewithPTSDand/orsubstanceusedisorder(SUD).Thirteenstudies were included in this review. 157 These studies produced low to very low-qualityevidence of small effect sizes that showed that individual trauma-focused psychologicaltherapy delivered alongside SUD therapy did better than treatment as usual/minimalinterventioninreducingPTSDseveritypost-treatmentandatlong-termfollow-up,butonlyreduced SUD at long-term follow-up. The second review 158 explored the effectiveness ofmedications for treating anxiety disorders and comorbid alcohol use disorders. Five trialswere included in this review. These studies provided a small amount of very low-qualityevidence that medication may reduce severity of anxiety symptoms, but no evidence ofefficacyforalcoholusesymptoms.
Table51.DownsandBlackChecklistqualityassessmentscoresforstudiesincludedinkeyclinicalquestion9
Reporting(Overallstudyquality)
Externalvalidity
Internalvalidity(Studybias)
Internalvalidity(Confoundingandselectionbias)
Powerofstudy
Total
Grothuesetal2008 10 3 6 6 1 25
Table52Listofexistingreviewsaddressingkeyclinicalquestion9
ReviewTitle ReviewAuthor Reviewtype
AMSTARscore
Psychologicaltherapiesforpost-traumaticstressdisorderandcomorbidsubstanceusedisorder
Robertsetal157 Cochranesystematicreview
10
Pharmacotherapyforanxietyandcomorbidalcoholusedisorders158
Ipseretal158 Cochranesystematicreview
11
144
Table53.Listofexistingpracticeguidelinesaddressingkeyclinicalquestion9
GuidelineTitle GuidelineAuthor/Publisher
Date AGREE-IIScore
Clinicalpracticeguidelineforthemanagementofsubstanceusedisorders66
DepartmentofVeteran'sAffairs
2015 83%
Generalisedanxietydisorderandpanicdisorderinadults(CG113)16
NICE 2011 83%
Alcohol-usedisorders:diagnosis,assessmentandmanagementofharmfuldrinkingandalcoholdependence(NICE,2011)15
NICE 2011(2015)
90%
Drugmisuseinover16s:opioiddetoxification(CG52)155 NICE 2007(2014)
83%
Diagnosisandtreatmentofpost-traumaticstressdisorderinemergencyserviceworkers98
BlackDogInstitute,TheUniversityofNewSouthWales
2015 73%
Prescribingdrugsofdependenceingeneralpractice156 RACGP 2015 67%
145
Table54.GRADEEvidenceProfileTable:Inpatientswithwork-relatedmentalhealthconditions,whatinterventionsareeffectiveatmanagingcomorbidsubstancemisuseandaddictivedisordersbyGPs?
QualityAssessment(GRADECriteria) No.ofparticipants Effect
GRADE CommentsMHC No.ofstudies(n)
StudyDesign
RiskofBias
Inconsistency
Indirectness
Imprecision
OtherConsiderations
Intervention
Control Absolute
Relative
Drinkingproblemsandcomorbiddepressiveand/oranxietydisorders
1159 RCT None None None Notserious
SinglehighqualityRCT
131 139 6.9to7.1g/alcohol/day
- HIGH Non-significanteffect
Interventions:Briefinterventions(BI)toreduceproblematicdrinkingwhichincludedalcoholrelatedtelephonecounselling:Steppedcare(max3sessionsatone,three,andsixmonthsfrombaseline),orfullcare(foursessionsimmediatelyfollowingbaselineassessment,plusafterone,three,andsixmonths,vscontrol(noalcoholrelatedintervention/counselling,onlysenthealthbehaviourinformationbooklet)
Outcome:Effectivemanagement(alcoholconsumption):• Theinterventionhadagreaterbutnon-significantreductioninalcoholconsumptionat12months.• Theinterventionwassignificantlyassociatedwithreducedalcoholconsumptioninthosewithoutcomorbidanxiety/depressionthanthosewith
comorbidanxiety/depression.
146
12 Keyclinicalquestion10:Inworkerswithamentalhealthcondition,whatinformationshouldaGPconsidertodeterminewhetherapersoniscapableandhascapacityto(returnto)work?
12.1 Evidencereviewroundone 12.1.1 PICO
PWorkersIFactorsthatdetermineaperson’scapacityto(returnto)work(e.g.recoverygoal
setting)CAllfactorsregardingpatientcareOManagingpatientexpectations;Patientsatisfaction;Returntowork;Adoptingor
utilisingastrength-basedapproach;Vocationalassessments;Improvementofsleepdisorders,Function,s=Socialinteraction
12.1.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
1. ((Mentaladjhealth)or(Psychiatricadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*))or(Mentaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Psychologicaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Depressiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(Moodadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Affectiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Adjustmentadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Posttraumaticadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AnxietyorstressorDepressionorVicarioustrauma)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
2. ((((Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor((joborworkoremploymentortrade)adjrelated)oroccupational)adj(disease*orillness*orhealth))orCompensation)adj(claim*orcompensation)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
3. (ReturntoworkorRecov*orImprov*orResolution*orresolv*orRespon*oroutcome*or(treatmentadjoutcome*)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
147
4. (ReturntoworkorEvaluation*orDecision*orPrognosisorIndicat*orGuide*ormarker*orAbsenteeismorSickleaveorSicknesscertificat*orWorkScheduleTolerance*orWorkperformance*or(Workadj(abilit*orcapacit*ordisabilit*orread*))or(Modifiedadj(workordut*))or(Workadjread*)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
5. 3or4
6. 1and2and5
12.1.3 SearchStrategy:CINAHL
# Query Limiters/Expanders
S1
“Mentalhealth”or(PsychiatricAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*))or(MentalAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(PsychologicalAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(DepressiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(MoodAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AffectiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AdjustmentAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or((“Posttraumatic”ORtraumatic)AND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))orAnxietyorstressorDepressionor“Vicarioustrauma”
Searchmodes-Boolean/Phrase
S3
(GeneralAND(practi*orphysician*ordoctor))or(FamilyAND(practi*orphysician*ordoctor*))or(Familymedic*(practi*ordoctor*))or(“Primarycare”AND(practi*orphysician*ordoctor*))or(“Occupationalhealth”AND(practi*orphysician*ordoctor*orspecialist*))or“companyphysician*”
Searchmodes-Boolean/Phrase
S4
Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor“jobrelated”or“workrelated”or“employmentrelated”or“traderelated”or“occupationaldisease*”or“occupationalillness*”or“occupationalhealth”orCompensationorclaim*
Searchmodes-Boolean/Phrase
S6"Returntowork"orRecov*orImprov*orResol*orresolv*orRespon*oroutcome*or"treatmentoutcome*"
Searchmodes-Boolean/Phrase
S13"Returntowork"OREvaluation*ORDecision*ORPrognosisORIndicat*ORGuide*ORmarker*ORAbsenteeismOR"Sick*
Searchmodes-Boolean/Phrase
148
leave"OR"Sicknesscertificat*"OR"WorkScheduleTolerance*"OR"Workperformance*"OR"Workabilit*”OR“workcapacit*”OR“workdisabilit*”OR“workread*”OR“Modifiedwork”OR“modifieddut*”OR“Workread*”
S35 S6ORS13Searchmodes-Boolean/Phrase
S36 S1ANDS4ANDS35Searchmodes-Boolean/Phrase
S37 S3ANDS36
Limiters-EnglishLanguage;AgeGroups:Adolescence,13-18years,Adult,19-44years,MiddleAge,45-64years,Aged,65+years,Aged,80andoverSearchmodes-Boolean/Phrase
12.1.4 Searchperiod
Databaseinceptiontothe31stofJanuary2017.
12.1.5 PRISMAround1
Embase,Medline,PsycINFOandAMEDreturnedn=103recordsandCINAHLreturnedn=1625records.
149
Figure40.RoundonePRISMAchartforkeyclinicalquestion10
12.2 RecommendationsarisingfromtheGuidelineDevelopmentGroupmeeting
- ReviseKeyclinicalquestion10toread:“Inworkerswithamentalhealthcondition,what
informationshouldaGPconsidertodeterminewhetherapersonhascapacitytoreturnto
work?”
- RemoveGPaspectfromsearchinclusioncriteria.
- Betterdefinesearchoutcomestoinclude:alternativeduties,suitableduties,considering
patientfactors(healthandwellbeing),workplace/workenvironment(e.g.psychosocial)
factors.Readinesstofacestigmawhenreturningtowork.
12.3 Evidencereviewroundtwo12.3.1 PICO
PWorkerswithmentalhealthconditionsITypesofinformationCBetweentypesofinformationODeterminationofcapacitytoreturntowork
150
12.3.2 SearchStrategy:Embase,Medline,PsycINFOandAMED
1. ((Mentaladjhealth)or(Psychiatricadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*))or(Mentaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Psychologicaladj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Depressiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(Moodadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Affectiveadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Adjustmentadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(Posttraumaticadj(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))orAnxietyorstressorDepression).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,t
2. (Recov*orImprov*orResolution*orresolv*orRespon*oroutcome*orprogressor(personaladjrecovery)orCHIMEorconnectednessorhopeoroptimismoridentityor(meaningadj2life)orempowermentor(treatmentadjoutcome*)or(failureadj2improve)or((patientorworkeroremployee)adj(healthorwellbeing))).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
3. ((Return*adj2work)orrtworAbsenteeismorSickleaveorSicknesscertificat*orWorkScheduleTolerance*orWorkperformance*or(Workadj(abilit*orcapacit*ordisabilit*orread*))or(suitableadjdut*)or(alternativeadjdut*)or(Modifiedadj(workordut*))or(Workadjread*)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
4. (Evaluation*orDecision*orIndicat*orprognosisorGuide*ormarker*orWorkScheduleTolerance*orAbsenteeismorWorkperformance*or(workadjenvironment)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
5. 1and2and3and4and((Generaladj(practi*orphysician*ordoctor))or(Familyadj(practi*orphysician*ordoctor*))or(Familyadjmedic*adj(practi*ordoctor*))or(Primaryadjcareadj(practi*orphysician*ordoctor*))or(Occupationaladj2(practi*orphysician*ordoctor*orspecialist*))or(companyadjphysician*)).mp.[mp=ab,hw,ti,tn,ot,dm,mf,dv,kw,fx,nm,kf,px,rx,ui,sy,tc,id,tm]
6. limit5toEnglishlanguage
151
12.3.3 SearchStrategy:CINAHL
# Query Limiters/Expanders
S1
“Mentalhealth”or(PsychiatricAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*))or(MentalAND(healthordisorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(PsychologicalAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(DepressiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsuffering))or(MoodAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AffectiveAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or(AdjustmentAND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))or((“Posttraumatic”ORtraumatic)AND(disorder*orillness*ordisease*orcondition*orailment*orepisode*orsufferingorstress*ordistress))orAnxietyorstressorDepression
Searchmodes-Boolean/Phrase
S3
(GeneralAND(practi*orphysician*ordoctor))or(FamilyAND(practi*orphysician*ordoctor*))or(Familymedic*(practi*ordoctor*))or(“Primarycare”AND(practi*orphysician*ordoctor*))or(“Occupationalhealth”AND(practi*orphysician*ordoctor*orspecialist*))or“companyphysician*”
Searchmodes-Boolean/Phrase
S4
Worker*orstafforemployee*orworkplace*orvocation*orworkoroccupation*oremploymentorjobortradeor“jobrelated”or“workrelated”or“employmentrelated”or“traderelated”or“occupationaldisease*”or“occupationalillness*”or“occupationalhealth”orCompensationorclaim*
Searchmodes-Boolean/Phrase
S6"Returntowork"orRecov*orImprov*orResol*orresolv*orRespon*oroutcome*or"treatmentoutcome*"
Searchmodes-Boolean/Phrase
S13
"Returntowork"OREvaluation*ORDecision*ORPrognosisORIndicat*ORGuide*ORmarker*ORAbsenteeismOR"Sick*leave"OR"Sicknesscertificat*"OR"WorkScheduleTolerance*"OR"Workperformance*"OR"Workabilit*”OR“workcapacit*”OR“workdisabilit*”OR“workread*”OR“Modifiedwork”OR“modifieddut*”OR“Workread*”
Searchmodes-Boolean/Phrase
S35 S6ORS13Searchmodes-Boolean/Phrase
S36 S1ANDS4ANDS35Searchmodes-Boolean/Phrase
S37 S1ANDS3ANDS4ANDS35 Limiters-EnglishLanguage;
152
# Query Limiters/Expanders
AgeGroups:Adolescence,13-18years,Adult,19-44years,MiddleAge,45-64years,Aged,65+years,Aged,80andoverSearchmodes-Boolean/Phrase
12.3.4 Searchperiod
Databaseinceptiontothe30thofApril2017.
12.3.5 PRISMAround2
Embase,Medline,PsycINFOandAMEDreturnedn=316recordsandCINAHLreturnedn=2024records.
153
Figure41.CombinedroundoneandroundtwoPRISMAchartforkeyclinicalquestion10
12.4 ImplicationsofanErrorinthe“Work”SearchStringforKeyclinicalquestion10
Table55.Keyclinicalquestion10literaturesearchresultsandimplicationsarisingfromsearchstringsusedinrelationtowork
Evidence
Review
Rounds
Originalkeyclinicalquestion
10.Inworkers,whatinformationshouldaGPconsidertodeterminewhetherapersoniscapableandhascapacityto(returnto)work?
Ovidimplication CINAHL
implication
OVID
count
CINAHL
count
R1 - Mentalhealthconditions(includedvicarioustrauma)
- Work-relatedness- Returntowork/work
capacity
Workinthecompensablesetting
work 103
1625
Ifwork-relatednesssearchstringhadbeencorrectedto“work”
Work 274335 Noimpact
154
R2 RevisedKeyclinicalquestion
10.Inworkerswithamentalhealthcondition,whatinformationshouldaGPconsidertodeterminewhetherapersonhascapacitytoreturntowork?- Mentalhealthconditions
(includedvicarioustrauma)- Returntowork/work
capacity(including“alternativeduties”,“suitableduties”)
- Recovery(includingCHIME)
- Inceptionto30thApril2017
Workinthecompensablesetting
work 316
2024
Ifwork-relatednesssearchstringhadbeencorrectedto“work”Noimpact;“work”wasnotincludedinthesearchconceptbecauseitwasimplicitinthe“returntowork”
Work Noimpact
Noimpact
EvidenceReviewGroupRecommendation:Nochangeforkeyclinicalquestion10becauseofreturntoworkinthesearch.OurrecommendationistoacceptthefinalrecommendationasperGuidelineDevelopmentGroupmeeting3.
12.5 FindingsandGRADEEvidenceProfileTablesfromSystematicLiteratureReview:Keyclinicalquestion10
We identified a total of 11 publications meeting the inclusion criteria for key clinicalquestion 10. The publications included two papers 160 161 from the same study. Qualityassessment scores for the studies are presented in Table 56. Another publicationwas anexisting2015 clinicalpracticeguideline (AGREE-II score73%) from theBlackDog Institute162.
Qualitative narrative descriptions the 10 included primary studieswere derived from theviewsofworkers/patients,healthpractitioners,unions,andemployerswereidentifiedfromthe10studies.ThesearesummarisedinTable57,formingthebasisforinformationwhichGPsmay consider in determination of capacity to return to work. The information givesconsiderationstobothphysicalandpsychosocialfactors,includingpersonalandworkplacepsychosocial factors. Some of the information has direct implications forconsideration/implementation within the scope of GP practice, while other information,particularlyrelatingtotheworkplaceenvironment,maybeusefulforawarenesspurposesinrelationtoGPdecisionsaroundreturntoworkplanning.
155
Table56.DownsandBlackChecklistqualityassessmentscoresforstudiesincludedinkeyclinicalquestion10
Reporting
(Overallstudy
quality)
External
validity
Internal
validity(Study
bias)
Internalvalidity
(Confoundingand
selectionbias)
Power
ofstudy
Total
Foleyetal2013163 9 3 4 5 0 21
Arendsetal2014164 10 3 5 4 0 22
Heesetal2012a161
b160 9 3 5 4 0 21
Corbiereetal2015165 6 2 4 3 0 15
ShielsandGabbay2007166 8 2 5 3 0 18
Soklaridisetal2011167 7 2 5 3 0 17
Linderetal2009168 7 3 2 2 0 14
Shielsetal2004169 10 3 4 2 0 19
Moretelmansetal2007170 8 3 4 2 0 17
Macdonaldetal2012171 7 3 4 2 0 16
Mean 8.1 2.7 4.2 3 0 18SD 1.4 0.5 0.9 1.1 0.0 2.7
Theguidelinelistedthefollowingrecommendationsthatwereconsideredtoberelevanttothiskeyclinicalquestion:
1. Positionsshouldbeprovidedthatallowalternativedutiesthatarenon-stigmatisingand, where possible, commensurate with the worker’s level of experience andseniority.
2. Clinicians should consider the possibility of adjusted duties and partial return towork as ways of promoting recovery and reducing the risk of long-term sicknessabsence.
3. The risk of self-harm, aggression and violence needs to be regularly assessedthroughouteachstageoftreatmentinanyemergencyworkerwithPTSD.Theriskofthese behaviours recurring requires reassessment when returning a worker tofrontlineduties.
156
Table57.GRADEEvidenceProfileTable:Inworkerswithamentalhealthcondition,whatinformationshouldaGPconsidertodeterminewhetherapersonhascapacitytoreturntowork?
QualityAssessment(GRADECriteria) No.ofparticipan
ts
Effect GRADE
CommentsMHC No.of
studiesStudyDesign
RiskofBias Inconsistency Indirectness Imprecision OtherConsiderations Absolute
Relative
CommonMHCs;Twohypotheticalsforsicknessabsence:onepsychologicalandoneofaphysicalnature.
3161163164 RCT Notserious Serious NotSerious none Europeanstudies;Fitnessforworkassessedinhypotheticalcases
337 MOD
Outcome:Capacitytoreturntowork:• InformationforGPtoconsider
“…considerinformationrelatingtosocial,domestic,financial,lifestyleandworkplacefactors,includingworkload,jobsatisfaction,jobstrain,workethic,interstaffrelationshipsandemployeesupportmechanisms”
• Relationshipbetweenworker/supervisorandsupervisor“conflictswithsupervisorincreasedtheoddsofrecurrentsicknessatsixand12months”
• Patientmotivationtoreturntowork“…25%ofourparticipantsachievedsymptomremissionwithoutachievinglongtermreturntowork,underlinestheimportanceoftargeting…multiplefactors…vocationalrehabprofessionals,employersandpatientswhoallregardworkmotivationascrucialforachievingareturntowork”
Depression,anxiety,adjustmentdisorders,unspecifiedmildmentaldisorders,unspecifiedworkdisability/limitations
7165-171 Cross-sectional;cohort
notserious notserious serious notserious Mixedgroupofpatients/employees,healthpractitioners,unions,employers
4720 - - MOD
Outcome:Capacitytoreturntowork:Managingpatientexpectations
• Patientage:Everyyearofageaboveanaverageof40-year-oldwassignificantlyassociatedwith5%morelikelihoodoflongtermabsence(>28weeks),contributing4%toriskoflongtermsicknessabsence
• Multiplicativeeffectofageandsocialdeprivationonlongtermsicknessabsence,“olderandmoredeprivedclaimantsweresignificantlymorelikelytohaveover28weekscertification.”
• Gender:maleshada36%chanceoflongtermabsence,althoughtheeffectofthiswasverysmall(0.2%contributiontoriskofsicknessabsence)• Midmentaldisordersweresignificantlyassociatedwithagreaterriskoflongtermsicknesscomparedtootherlargely,physicalconditions–an88%likelihood
andcontributing18.5%toriskoflongtermabsence“…diagnosisandageappeartohavesignificanteffectsonriskoflongtermpatientincapacity…”
• Individualisedapproachtomanagingexpectations,takingintoaccount“…typeofjob,thepatient’shomesituation,relationshipwithemployers,provisionforoccupationalhealthinputfromemployers”andmotivation“…notwithstandingthebenefitsofwork,remaininginworkcouldbedetrimentalforsomepatients…GPsmustestablish,innegotiationwiththedepressedpatient,whatroleworkassumesintheirillnessexperienceandhowworkfeaturesintheplannedmanagementofdepression”
157
Returntowork• Workenvironment:unhealthypsychosocialworkplaceandworkpoliciesmayimpedereturntoworkvsworkpracticesthatpromoteemployeesmentalhealth
wellbeing,“Atoxicworkclimatecantakemanyforms:harassment,excessivecompetitivenessresultingfromperformancemanagementpoliciesorademotivatingatmosphere…(1)itcancreateanenvironmentconducivetoburnoutordepressionand(2)itcanpromoterelapses.”“…aworkenvironmentsensitivetomentalhealthissuesisafacilitatorofthereturn-to-work.”
• Physicalcomorbidity/musculoskeletalpainweresignificantlyassociatedwithdepressioninthoseexperiencingdifficultyreturningtowork• Appropriatemedicaltreatmentandaccesstospecialistmentalhealthservice
“…someemployeesgoonsickleaveforafewweekswithouthavinganymedicalorpsychologicaltreatment,andincreasingthechancesofrelapsewhenreturningtowork.”“…lackofaccesstospecializedmentalhealthconsultationhasalsobeenreportedasbeingabarriertoreturn-to-work.”
• Familyphysicianslackofknowledgeoftheworkplaceanditslimitations;underscorescollaborativeaspectsofdecisionsaroundcapacityassessmentandreturntoworkplanning
• Socialdeprivationisariskfactorforlongertermworkincapacityand“…asubstantialproportionofthepatientswithmildmentalproblemsmayfallintothiscategory”and“…maybenefitfrominterventionstoenablethemtorecoverandreturntowork,reducingtheirriskoflong-termabsencefromtheworkforce”
Vocationalassessmentsandstrengthbasedapproach• Collaborationwiththeorganisations’stakeholderstofacilitatesuitabilityofworkandinterdisciplinarymeetingtofacilitateinformationsharingand
formulationofstrategiestomaximisereturntowork;takingintoaccountworkplacepsychosocialenvironment,modifiedduties“Thereturn-to-workratecanbedoubledforsick-listedemployeesthathaveaccesstomodifiedworkcomparedtosick-listedemployeesthatdonothaveaccesstomodifiedwork.”
• Multidisciplinaryworkingabilityassessmentreportsandrecommendationregardingtheprocessandplanforreturntowork,i.e.rehabilitationthatmaybemedicaland/orvocational,orreturntoworkonmodifiedduties
Improvementofsleepdisorders,function,socialinteraction• Assess/identifypresenceoforpersistentdifficultywithsleep,participationinleisureactivitiesaspotentialindicatorsofsymptomaticrecovery
“Thepsychiatric–somaticcomorbiditygroupshowedhigherfrequenciesforinsomnia‘everynight’(37%)and‘often’(43%),asdidalsothepsychiatriconlygroup(35and43%)”“Morepatientswiththepsychiatricdiagnosisonly(42%)thanwithsomaticdiagnosisonly(24%)hadceasedallearlierleisureactivities,andabouthalfofallpatientsreportedlessleisureactivitythanbefore”
• Patientphysicalandpsychosocialcapability.Workersexperiencingdifficultyresumingworksignificantlyexhibitedphysicalactivityandfunctionallimitations:considerpersonal/extra-vocationalpersonalcircumstances(despondencyorunhappinesswithpersonallife),andthepatient’s/employee’sattitudetowardswork(anxietiesaboutreturningtotheworkenvironmentrelatedtoworkabsence)
• Differentialdiagnosis–assessmentofpossiblemalingering.Returntoworkmaybeimpededinsituationswherethepatienthaspersonalgain,orwherethereisanincentiveforprolongedabsence.
Patientsatisfaction• Noneofthestudiesconsideredpatientsatisfaction
158
13 Appendices
13.1 Appendix1QualityAssessmentofDiagnosticAccuracyStudies(QUADAS)
Checklist
Source:https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/1471-2288-3-25
QUADASItem Yes No Unclear1.Wasthespectrumofpatientsrepresentativeofthepatientswhowillreceivethetestinpractice?
2.Wereselectioncriteriaclearlydescribed?
3.Isthereferencestandardlikelytocorrectlyclassifythetargetcondition?
4.Isthetimeperiodbetweenreferencestandardandindextestshortenoughtobereasonablysurethatthetargetconditiondidnotchangebetweenthetwotests?
5.Didthewholesampleorarandomselectionofthesample,receiveverificationusingareferencestandardofdiagnosis?
6.Didpatientsreceivethesamereferencestandardregardlessoftheindextestresult?
7.Wasthereferencestandardindependentoftheindextest(i.e.theindextestdidnotformpartofthereferencestandard)?
8.Wastheexecutionoftheindextestdescribedinsufficientdetailtopermitreplicationofthetest?
9.Wastheexecutionofthereferencestandarddescribedinsufficientdetailtopermititsreplication?
10.Weretheindextestresultsinterpretedwithoutknowledgeoftheresultsofthereferencestandard?
11.Werethereferencestandardresultsinterpretedwithoutknowledgeoftheresultsoftheindextest?
12.Werethesameclinicaldataavailablewhentestresultswereinterpretedaswouldbeavailablewhenthetestisusedinpractice?
13.Wereuninterpretable/intermediatetestresultsreported?
14.Werewithdrawalsfromthestudyexplained?
159
13.2 Appendix2PatientHealthQuestionnaire-9(PHQ-9)
Source:http://www.phqscreeners.com/sites/g/files/g10016261/f/201412/PHQ-9_English.pdf
160
13.3 Appendix3Four-DimensionalSymptomQuestionnaire(4DSQ)
Source:http://www.midss.org/sites/default/files/4dsq_eng_revison2010.pdf
The following isa listofquestionsaboutvariouscomplaintsandsymptomsyoumayhave.Eachquestionrefersto thecomplaintsandsymptomsthatyouhadinthepastweek(thepast7days,includingtoday).Complaintsyou hadbeforethen,butnolongerhadduringthepastweek,donotcount.
Pleaseindicateforeachcomplainthowoftenyounoticedthatyouhaditinthepastweekbyputtingan“X”inthe boxundertheanswerthatismostappropriate.
During the past week, did you suffer from: no sometimes regularly often very often or constantly
1. dizziness or feeling light-headed? - - - - - - - - - - - -
c c c c c
2. painful muscles? - - - - - - - - - - - - - - - - - - - - - - - -
c c c c c
3. fainting? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
c c c c c
4. neck pain? - - - - - - - - - - - - - - - - - - - - - - - - - - - -
c c c c c
5. back pain? - - - - - - - - - - - - - - - - - - - - - - - - - - - -
c c c c c
6. excessive sweating? - - - - - - - - - - - - - - - - - - - - -
c c c c c
7. palpitations? - - - - - - - - - - - - - - - - - - - - - - - - - - -
c c c c c
8. headache? - - - - - - - - - - - - - - - - - - - - - - - - - - - -
c c c c c
9. a bloated feeling in the abdomen? - - - - - - - - - - - -
c c c c c
10. blurred vision or spots in front of your eyes? - - - - -
c c c c c
11. shortness of breath? - - - - - - - - - - - - - - - - - - - - -
c c c c c
12. nausea or an upset stomach? - - - - - - - - - - - - - - -
c c c c c
During the past week, did you suffer from: no sometimes regularly often very often or constantly
13. pain in the abdomen or stomach area? - - - - - - - -
c c c c c
14. tingling in the fingers? - - - - - - - - - - - - - - - - - - - -
c c c c c
15. pressure or a tight feeling in the chest? - - - - - - - -
c c c c c
16. pain in the chest? - - - - - - - - - - - - - - - - - - - - - - -
c c c c c
17. feeling down or depressed? - - - - - - - - - - - - - - - -
c c c c c
18. sudden fright for no reason? - - - - - - - - - - - - - - - -
c c c c c
19. worry? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
c c c c c
20. disturbed sleep? - - - - - - - - - - - - - - - - - - - - - - - -
c c c c c
21. a vague feeling of fear? - - - - - - - - - - - - - - - - - - -
c c c c c
22. lack of energy? - - - - - - - - - - - - - - - - - - - - - - - - -
c c c c c
23. trembling when with other people? - - - - - - - - - - -
c c c c c
24. anxiety or panic attacks? - - - - - - - - -- - - - c c c c c
© Copyright 1996 by Dr. B. Terluin, Almere, the Netherlands, text revision 2010
161
During the past week, did you feel: no sometimes regularly often very often or constantly
25. tense? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
c c c c c
26. easily irritated? - - - - -- - - - - - - - - - - - - - - - - - - - -
c c c c c
27. frightened? - - - - - - - - - - - - - - - - - - - - - - c c c c c
During the past week, did you feel: no sometimes regularly often very often or constantly
28. that everything is meaningless? - - - - - - - - - - - - - -
c c c c c
29. that you just can't do anything anymore? - - - - - - -
c c c c c
30. that life is not worth while? - - - - - - - - - - - - - - - - -
c c c c c
31. that you can no longer take any interest in the people and things around you? - - - - - - - - - - - - - -
c
c
c
c
c
32. that you can't cope anymore? - - - - - - - - - - - - - -
c c c c c
33. that you would be better off if you were dead? - - -
c c c c c
34. that you can't enjoy anything anymore? - - -- - - - -
c c c c c
35. that there is no escape from your situation? - - - - -
c c c c c
36. that you can't face it anymore? - - - - - - - - - - - -
c c c c c
During the past week, did you: no sometimes regularly often very often or constantly
37. no longer feel like doing anything? - - - - - - - - - - -
c c c c c
38. have difficulty in thinking clearly? - - - - - - - - - - - -
c c c c c
39. have difficulty in getting to sleep? - - - - - - - - - - - -
c c c c c
40. have any fear of going out of the house alone? - - - - - - - - - - - - - - - - - - - - - - - - - - - c c c c c
© Copyright 1996 by Dr. B. Terluin, Almere, the Netherlands, text revision 2010
162
During the past week: no sometimes regularly often very often or constantly
41. did you easily become emotional? - - - - - - c c c c c
42. were you afraid of anything when there was really no need for you to be afraid? (for instance animals, heights, small rooms) - -- c c c c c
43. were you afraid to travel on buses, streetcars/trams, subways or trains? - - - - - c c c c c
44. were you afraid of becoming embarrassed when with other people? - - - - - - - - - - - - - c c c c c
45. did you ever feel as if you were being threatened by unknown danger? - - - - - - -- c c c c c
46. did you ever think "I wish I was dead"? - - - c c c c c
47. did you ever have fleeting images of any upsetting event(s) that you have experienced? - - - - - - - - - - - - - - - - - - - - - c c c c c
48. did you ever have to do your best to put aside thoughts about any upsetting event(s)? - - c c c c c
49. did you have to avoid certain places because they frightened you? - - - - - c c c c c
50. did you have to repeat some actions a number of times before you could do something else? - - - - - - - - - - - - - - - - - - - c c c c c
© Copyright 1996 by Dr. B. Terluin, Almere, the Netherlands, text revision 2010
163
13.4 Appendix4PosttraumaticStressDisorderChecklist-Civilianversion(PCL-C))
Source: https://www.mirecc.va.gov/docs/visn6/3_PTSD_CheckList_and_Scoring.pdf
PCL-M for DSM-IV (11/1/94) Weathers, Litz, Huska, & Keane National Center for PTSD - Behavioral Science Division
Instruction to patient: Below is a list of problems and complaints that veterans sometimes have in response to stressful life experiences. Please read each one carefully, put an “X” in the box to indicate how much you have been bothered by that problem in the last month.
ResponseNotatall
(1)Alittlebit
(2)Moderately
(3)Quiteabit
(4)Extremely
(5)1. Repeated,disturbingmemories,thoughts,or
imagesofastressfulexperiencefromthepast?
2. Repeated,disturbingdreamsofastressful experiencefromthepast?
3. Suddenlyactingorfeelingasifastressfulexperiencewerehappeningagain(asifyouwererelivingit)?
4. Feelingveryupsetwhensomethingremindedyouofastressfulexperiencefromthepast?
5. Havingphysicalreactions(e.g.,heartpounding, troublebreathing,orsweating)whensomething remindedyouofastressfulexperiencefromthe past?
6. Avoidthinkingaboutortalkingaboutastressfulexperiencefromthepastoravoidhavingfeelings relatedtoit?
7. Avoidactivitiesorsituationsbecausetheyremindyouofastressfulexperiencefromthepast?
8. Troublerememberingimportantpartsofastressful experiencefromthepast?
9. Lossofinterestinthingsthatyouusedtoenjoy? 10. Feelingdistantorcutofffromotherpeople? 11. Feelingemotionallynumborbeingunableto
have lovingfeelingsforthoseclosetoyou?
12. Feelingasifyourfuturewillsomehowbecutshort?
13. Troublefallingorstayingasleep? 14. Feelingirritableorhavingangryoutbursts? 15. Havingdifficultyconcentrating? 16. Being“superalert”orwatchfulonguard? 17. Feelingjumpyoreasilystartled?
164
13.5 Appendix5DepressionAnxietyStressScales
Source:http://www2.psy.unsw.edu.au/dass/down.htm
Pleasereadeachstatementandcircleanumber0,1,2or3whichindicateshowmuchthestatementappliedto you over the past week. There are no right or wrong answers. Do not spend too much time on anystatement.
Theratingscaleisasfollows:
0Didnotapplytomeatall1Appliedtometosomedegree,orsomeofthetime2Appliedtometoaconsiderabledegree,oragoodpartoftime3Appliedtomeverymuch,ormostofthetime
1 Ifoundmyselfgettingupsetbyquitetrivialthings 0123
2 Iwasawareofdrynessofmymouth 0123
3 Icouldn'tseemtoexperienceanypositivefeelingatall 0123
4 Iexperiencedbreathingdifficulty(eg,excessivelyrapidbreathing,breathlessnessintheabsenceofphysicalexertion)
0123
5 Ijustcouldn'tseemtogetgoing 0123
6 Itendedtoover-reacttosituations 0123
7 Ihadafeelingofshakiness(eg,legsgoingtogiveway) 0123
8 Ifounditdifficulttorelax 0123
9 IfoundmyselfinsituationsthatmademesoanxiousIwasmostrelievedwhentheyended
0123
10 IfeltthatIhadnothingtolookforwardto 0123
11 Ifoundmyselfgettingupsetrathereasily 0123
12 IfeltthatIwasusingalotofnervousenergy 0123
13 Ifeltsadanddepressed 0123
14 IfoundmyselfgettingimpatientwhenIwasdelayedinanyway(eg,lifts,trafficlights,beingkeptwaiting)
0123
15 Ihadafeelingoffaintness 0123
16 IfeltthatIhadlostinterestinjustabouteverything 0123
17 IfeltIwasn'tworthmuchasaperson 0123
18 IfeltthatIwasrathertouchy 0123
19 Iperspirednoticeably(eg,handssweaty)intheabsenceofhightemperaturesorphysicalexertion
0123
20 Ifeltscaredwithoutanygoodreason 0123
21 Ifeltthatlifewasn'tworthwhile 0123
165
13.6 Appendix6.GeneralizedAnxietyDisorder7-item(GAD-7)scale
Source:https://www.integration.samhsa.gov/clinical-practice/GAD708.19.08Cartwright.pdf
166
13.7 Appendix7(AUDIT)Questionnaire
Source: http://auditscreen.org/~auditscreen/cmsb/uploads/audit-english-version-new_001.pdf Pleasecircletheanswerthatiscorrectforyou1.Howoftendoyouhaveadrinkcontainingalcohol?
• Never• Monthlyorless• 2-4timesamonth• 2-3timesaweek• 4ormoretimesaweek
2.Howmanystandarddrinkscontainingalcoholdoyouhaveonatypicaldaywhendrinking?
• 1or2• 3or4• 5or6• 7to9• 10ormore
3.Howoftendoyouhavesixormoredrinksononeoccasion?• Never• Lessthanmonthly• Monthly• Weekly• Dailyoralmostdaily
4.Duringthepastyear,howoftenhaveyoufoundthatyouwerenotabletostopdrinkingonceyouhadstarted?
• Never• Lessthanmonthly• Monthly• Weekly• Dailyoralmostdaily
5.Duringthepastyear,howoftenhaveyoufailedtodowhatwasnormallyexpectedofyoubecauseofdrinking?
• Never• Lessthanmonthly• Monthly• Weekly• Dailyoralmostdaily
6.Duringthepastyear,howoftenhaveyouneededadrinkinthemorningtogetyourselfgoingafteraheavydrinkingsession?
• Never• Lessthanmonthly• Monthly
167
• Weekly• Dailyoralmostdaily
7.Duringthepastyear,howoftenhaveyouhadafeelingofguiltorremorseafterdrinking?
• Never• Lessthanmonthly• Monthly• Weekly• Dailyoralmostdaily
8.Duringthepastyear,haveyoubeenunabletorememberwhathappenedthenightbeforebecauseyouhadbeendrinking?
• Never• Lessthanmonthly• Monthly• Weekly• Dailyoralmostdaily
9.Haveyouorsomeoneelsebeeninjuredasaresultofyourdrinking?• No• Yes,butnotinthepastyear• Yes,duringthepastyear
10.Hasarelativeorfriend,doctororotherhealthworkerbeenconcernedaboutyourdrinkingorsuggestedyoucutdown?
• No• Yes,butnotinthepastyear• Yes,duringthepastyear
ScoringtheAUDIT:Scoresforeachquestionrangefrom0to4,withthefirstresponseforeachquestion(egnever)scoring0,thesecond(eglessthanmonthly)scoring1,thethird(egmonthly)scoring2,thefourth(egweekly)scoring3,andthelastresponse(eg.Dailyoralmostdaily)scoring4.Forquestions9and10,whichonlyhavethreeresponses,thescoringis0,2and4(fromlefttoright).Ascoreof8ormoreisassociatedwithharmfulorhazardousdrinking,ascoreof13ormoreinwomen,and15ormoreinmen,islikelytoindicatealcoholdependence.
168
13.8 Appendix8.SeverityOfAlcoholDependenceQuestionnaire(SADQ)
Source: https://www.alcohollearningcentre.org.uk/Topics/Latest/Severity-of-Alcohol-Dependence-Questionnaire-SADQ/
Please recall a typical period of heavy drinking in the last 6 months. When was this? Month:………………………………. Year…………………………….. Please answer all the following questions about your drinking by circling your most appropriate response.
During that period of heavy drinking
1. The day after drinking alcohol, I woke up feeling sweaty.
ALMOST NEVER SOMETIMES OFTEN NEARLY ALWAYS
2. The day after drinking alcohol, my hands shook first thing in the morning.
ALMOST NEVER SOMETIMES OFTEN NEARLY ALWAYS
3. The day after drinking alcohol, my whole body shook violently first thing in the morning if I didn't have a drink.
ALMOST NEVER SOMETIMES OFTEN NEARLY ALWAYS
4. The day after drinking alcohol, I woke up absolutely drenched in sweat.
ALMOST NEVER SOMETIMES OFTEN NEARLY ALWAYS
5. The day after drinking alcohol, I dread waking up in the morning.
ALMOST NEVER SOMETIMES OFTEN NEARLY ALWAYS
6. The day after drinking alcohol, I was frightened of meeting people first thing in the morning.
ALMOST NEVER SOMETIMES OFTEN NEARLY ALWAYS
7. The day after drinking alcohol, I felt at the edge of despair when I awoke.
ALMOST NEVER SOMETIMES OFTEN NEARLY ALWAYS
8. The day after drinking alcohol, I felt very frightened when I awoke.
ALMOST NEVER SOMETIMES OFTEN NEARLY ALWAYS
9. The day after drinking alcohol, I liked to have an alcoholic drink in the morning.
ALMOST NEVER SOMETIMES OFTEN NEARLY ALWAYS
10. The day after drinking alcohol, I always gulped my first few alcoholic drinks down as
quickly as possible.
ALMOST NEVER SOMETIMES OFTEN NEARLY ALWAYS
11. The day after drinking alcohol, I drank more alcohol to get rid of the shakes.
ALMOST NEVER SOMETIMES OFTEN NEARLY ALWAYS
12. The day after drinking alcohol, I had a very strong craving for a drink when I awoke.
ALMOST NEVER SOMETIMES OFTEN NEARLY ALWAYS
13. I drank more than a quarter of a bottle of spirits in a day (OR 1 bottle of wine OR 8 units of beers ).
169
ALMOST NEVER SOMETIMES OFTEN NEARLY ALWAYS 14. I drank more than half a bottle of spirits per day (OR 1.5 bottles of wine OR 15 units of beer).
ALMOST NEVER SOMETIMES OFTEN NEARLY ALWAYS 15. I drank more than one bottle of spirits per day (OR 3 bottles of wine OR 30 units of beer).
ALMOST NEVER SOMETIMES OFTEN NEARLY ALWAYS 16. I drank more than two bottles of spirits per day (OR 6 bottles of wine OR 60 units of beer)
ALMOST NEVER SOMETIMES OFTEN NEARLY ALWAYS Imagine the following situation: 1. You have been completely off drink for a few weeks
2. You then drink very heavily for two days
How would you feel the morning after those two days of drinking?
17. I would start to sweat.
NOT AT ALL SLIGHTLY MODERATELY QUITE A LOT
18. My hands would shake.
NOT AT ALL SLIGHTLY MODERATELY QUITE A LOT
19. My body would shake.
NOT AT ALL SLIGHTLY MODERATELY QUITE A LOT
20. I would be craving for a drink.
NOT AT ALL SLIGHTLY MODERATELY QUITE A LOT
SCORE _________
CHECKED BY:
ALCOHOL DETOX PRESCRIBED: YES/NO
170
13.9 Appendix9.LeedsDependenceQuestionnaire(LDQ)
Source: https://www.alcohollearningcentre.org.uk/_assets/leeds_dependence_questionnaire-ldq.doc
Here are some questions about the importance of alcohol or other drugs in your life. Think about the main substance you have been using over the last 4 weeks and tick the closest answer to how you see yourself
Never 0
Sometimes 1
Often 2
Nearly Always
3 Do you find yourself thinking about when you will next be able to have another drink or take more drugs?
Is drinking or taking drugs more important than anything else you might do during the day?
Do you feel that your need for drink or drugs is too strong to control?
Do you plan your days around getting and taking drink or drugs?
Do you drink or take drugs in a particular way in order to increase the effect it gives you?
Do you drink or take drugs morning, afternoon and evening?
Do you feel you have to carry on drinking or taking drugs once you have started?
Is getting an effect more important than the particular drink or drug you use?
Do you want to take more drink or drugs when the effects start to wear off?
Do you find it difficult to cope with life without drink or drugs?
171
13.10 Appendix10NHMRCTechnicalReportRequirementsChecklist B.ScopeandPurposeRequirement Addressedinourtechreport?Yes/NoMandatory B.1Thepurposeoftheguidelineisstated,includingtheclinicalquestions(seeRequirementC.1),issueorproblemstheguidelineaddresses.
YesIntroductionchaptersection1.1and1.3
C.EvidenceReviewRequirement Addressedinourtechreport?Yes/NoMandatory C.1Clinicalquestionsaddressedbytheguidelinearestatedinastructuredandconsistentformattodefinetheboundariesofthetopic,i.e.byspecifyingtherelevantpopulation,intervention/s(e.g.treatment/sordiagnostictest/s),comparator/sandoutcomesmeasured.
YesIntroductionchaptersection1.3.EachkeyclinicalquestionwasframedfollowingthePICOformatandthedifferentPICOelementsarestatedineachkeyclinicalquestionchapter3through12
C.2.Systematicsearchesforevidenceareundertakenandthesearchstrategyisdocumented,includingthesearchtermsanddatabasessearched.
YesMethodschapter.Searchstrategiesareprovidedineachkeyclinicalquestionchapter3through12
C.3.ThepopulationgroupsspecifiedinthesearchstrategyincludeAboriginalandTorresStraitIslanderpeoplesandanypopulationsubgroupsthathavebeenidentified(seeRequirementB.4andB.5).
Althoughspecialneedsgroupswerenotexplicitlyspecified,oursearchwasinclusive.Thereforeanyrelevantliteratureonsuchgroupswouldhavebeenpickedupbyoursearchandconsideredforreview.TheconsultationphaseaimstocanvasinputfromspecialinterestgroupstakeholdersinorganisationssuchastheRACGP,RACPandAboriginalandTorresStraitIslanderbodies.
C.4.Thepublicationperiodcoveredbythesearchesisstated,andthelatestdateiswithin12monthsofthefirstdayofpublicconsultationandwithin20monthsofsubmissionofthefinaldraftguidelinetoNHMRCforapproval.
YesMethodschaptersection2.1.ThesubstantivesearchperiodwasuptoendofApril2017andthelasttargetedsearch(keyclinicalquestion4)wason6thNovember2017.PublicconsultationisscheduledforJanuary2018andNHMRCapprovalinNovember2018.Thusthesearchperiodalignswellwiththesedatestomeetthecriterion.
C.5.Theinclusionandexclusioncriteriausedtoselectstudiesforappraisalaredescribed.
YesMethodschaptersections2.1.1-2.1.2
C.6.Foreachclinicalquestion,thedeveloperhasprovidedanevidencetable,whichsummarisesthesystematicassessmentandcriticalappraisalofallstudiesthatmeettheinclusioncriteria(i.e.thebodyofevidenceonwhicharecommendationwillbebased).Eachevidencetableshouldincludeinformationonstudydesign,outcomes,levelofevidence,thefindingsofmeta-analysis(ifperformed)andotherrelevantinformation.
YesChapters3-12providesummaryevidencetablesforeachkeyclinicalquestion.
C.7Foreachclinicalquestion,thedeveloperhasprovidedanevidencestatementform,whichdocumentsthesynthesisandevaluationofthebodyofevidencetodeterminethegradeofeachrecommendation,accordingtoanNHMRC-approvedmethod(NHMRCgradesforrecommendations10orGRADE11).
YesMethodschaptersection2.5outlinestheprocessandusingGRADEforqualityofevidenceratingandthestrengthoftherecommendations.TheelementsoftheNHMRCevidencestatementformareincorporatedintothesummaryevidencetableforeachkeyclinicalquestion(chapters3-12)
172
Desirable C.3.1Thepopulationgroupsspecifiedinthesearchstrategyincludegroupssuchasculturallyandlinguisticallydiversecommunitiesorothergroupsforwhomspecificsocioculturalfactors(includingethnicity,gender,age,disability,socioeconomicstatusandlocation)intreatmentorpreventionoutcomesshouldbeconsidered.
SeeC.3above
C.3.2Searchstrategiesincludesearchtermstoidentifyevidencerelatedtoconsumers’perceptionsandexperiences
YesAfocusedaspectofthisisaddressedbykeyclinicalquestion8
C.3.3Dependentontheguidelinescope,thesearchstrategyisdesignedtoidentifyevidenceforallrelevantalternativesforscreening,prevention,diagnosisortreatmentoftheconditionaddressedbytheguideline,includingrelevantcomplementaryandalternativemedicineapproaches.
YesTherescopewasinclusiveofallstrategiesforthediagnosisandmanagementofmentalhealthconditions;forexample,oneofthesearcheddatabaseswasadesignatedalliedandcomplementarymedicinedatabase
C.3.4Searchstrategiesincludesearchtermstoidentifyevidencerelatedtocosteffectivenessandresourceimplicationsofpractice.
NoThiswasoutsidethescopeofourguidelineandevidencereview.
173
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