Peer-to-Peer Webinar Series: Success Stories in EIDM / Webinar #3

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Peer-to-Peer Webinar: Success Stories in EIDM

Webinar 3 - Featuring:

Effective Psychological and Psychosocial Interventions to Prevent

Perinatal Depression and Anxiety Disorders: A Rapid Review and

Applicability Assessment

Becky Blair, John Barbaro, and Amy Faulkner

Simcoe Muskoka District Health Unit

Building a Best Practice Tool to Address the Needs of Clients with

Hepatitis C

Mary Guyton and Heidi Parker, Sherbourne Health Centre Site

November 15, 2017 1:00 – 2:30 PM ET

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The EIDM Casebook

• Collection of success

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eidm-casebook

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http://www.nccmt.ca/impact/eidm-casebook


Presenters

Becky Blair, RD, MSc

Simcoe Muskoka

District Health Unit

John Barbaro, MSc

Simcoe Muskoka


Amy Faulkner, MISt

Simcoe Muskoka


Simcoe Muskoka District Health Unit’sEIDM Team

Health Evidence Case Book SeriesNovember 15th, 2017

EFFECTIVE PSYCHOLOGICAL AND

PSYCHOSOCIAL INTERVENTIONS TO

PREVENT PERINATAL DEPRESSION AND

ANXIETY DISORDERS

OUTLINE

• Research Question Selection Process

• PICO & Search Strategy

• Study Selection & Quality Assessment Process

Description of Studies Included and Excluded

• Results

Characteristics of Included Systematic Reviews

Characteristics of Included Guidelines

Key Findings

• Applicability & Transferability

RESEARCH QUESTION

• Potential research questions were submitted by each health

unit department.

• Each question was scored (0-2) and ranked using pre-

established criteria and group consensus

• Top 3 choices were presented to Executive Committee for

endorsement.

• The top ranked question was the one selected for the Rapid

Review.

PICO

P (population) - pregnant or postpartum women at no known risk

or at risk of developing perinatal depression or an anxiety

disorder.

I (intervention) - any psychological or psychosocial intervention

C (comparison) - standard or usual care

O (outcome) - proportion of women diagnosed with perinatal

depression or an anxiety disorder

Lesson learned: The definitions document developed by the

EIDM team for the PICO was very helpful when screening studies

for inclusion / exclusion.

SEARCH STRATEGY

• The following databases were searched between January 20, 2016 - January

26, 2016:

Ovid MEDLINE(R) 1946 to January Week 1 2016

PsycINFO 2002 to January Week 2 2016

EMBASE 1996 to 2016 Week 3- limited to exclude Medline journals

CINAHL Plus with Full Text

Medline in process searched on January 25, 2016

Lesson learned: Ensure time to discuss iterations of the search with

key members of the team, save search strategies, document decision-

making process

STUDY SELECTION & QUALITY ASSESSMENT

• At least two team members screened the initial list of titles and

abstracts and then reviewed full text articles for inclusion/exclusion as

required– disagreements were brought to the entire group for

consensus.

• Full text articles went on to the quality assessment stage.

• Only systematic reviews and guidelines were considered for quality

assessment and inclusion in the rapid review results.

• All systematic reviews and meta-analyses were assessed using the

AMSTAR quality assessment tool. The two guidelines were appraised

using the AGREE II tool.

Lesson learned: Make sure everyone is clear in how the outcome of

interest is defined and measured.

EVIDENCE SEARCH AND SCREENING FLOW DIAGRAM

CHARACTERISTICS OF INCLUDED REVIEWS

Citation

(AMSTAR quality

assessment rating)

# studies with

outcome

(total # studies

in SR)

Study

designs

included in

systematic

review

Total

sample

size of

studies

with

outcome

Characteristics of

sample

Intervention

Type

(vs.

comparison/co

ntrol)

Outcome

Measure

Outcome

Dennis and

Dowswell9

(11)

5 (28) RCTs 458/481

Pregnant women

and new mothers,

both with and with-

out known risk.

psychological

and

psychosocial

(vs. TAU)

As variously defined

and measured by study

authors.

Diagnosis of

depression,

RR=0.50(0.32 to

0.78)

Pilkington et al.27

(2) 1/13

Matthey

(2004)28: 3 x3

RCT

Matthey

n=268

Couples expecting

first baby.

Australian sample.

Psycho-

education vs.

(non-specific

control) or TAU

Structured diagnostic

interview schedule-

DSM-IV

No effect on rates of

depression or

depression-anxiety

across conditions.

Sockol29

(5)

12 (40)RCTs and

quasi-RCTs3,149

Studies from

developed and

developing nations,

both antenatal and

postnatal.

CBT (vs. TAU,

active control, or

enhanced TAU)

Met criteria for

depressive episode.

No outcome definition

for prevention studies

provided.

OR= 0.71 (0.59-0.87)

Sockol30

(5)

23 (28)RCTs and

quasi-RCTs4,485

Studies from

developed and

developing nations,

both antenatal and

postnatal.

Biological and

psychosocial

intervention.

Various scales and

diagnostic criteria as

defined by primary

study authors,

including EDPS

Psychosocial

interventions:

OR = 0.61 (0.50, 0.84)

CHARACTERISTICS OF INCLUDED GUIDELINESCitation (AGREE II

quality assessment

rating)

Evidence Description Recommendations

National Institute for

Health and Care

Excellence (NICE)1

(7/7)

Social support vs TAU - preventing depression diagnosis (at risk

women) – intention-to-treat (ITT) analysis 1 study:

->RR 0.85 (0.65 to 1.1) 117 participants, VERY LOW QUALITY

CBT/IPT informed psychoeducation vs. TAU - preventing depression

diagnosis (at risk women) – ITT analysis 3 studies:

->RR 0.69 (0.45 to 1.05) 360 participants. LOW QUALITY.

Depression diagnosis intermediate follow (up) (17-24 weeks post)

ITT analysis. 1 study:

->RR 0.77 (0.33 to 1.75) 45 participants, LOW QUALITY.

Mother-infant relationship interventions vs TAU - preventing

depression diagnosis post-treatment (at risk women) – intention-to-

treat (ITT) analysis 1 study:

->RR 1 (0.76 to 1.31) 449 participants, LOW QUALIT.

No studies were found that assessed change in diagnosis of

depression in populations without risk.

There are no recommendations

specific to preventative interventions

for depression or anxiety disorders

in the antenatal or postnatal period.

BC Reproductive Mental

Health & Perinatal

Services BC.10

(4/7)

Regarding prenatal depression, the guideline cites a guideline from

Scotland31. It identified that current evidence does not support

specific interventions for the prevention of depression in pregnancy

in those without identified risk factors.

Regarding post-partum depression, the guideline describes

promising practices for all postpartum related outcomes (not just

prevalence of diagnosed postpartum depression) from Dennis and

Dowswell.9

There are no recommendations

specific to preventative interventions

for depression or anxiety disorders

in the antenatal or postnatal period.

Available case analysis from Table 1.3 of Dennis-Dowswell Cochrane Review

Intention-to-treat (ITT) analysis from Table 1.3 of Dennis-Dowswell Cochrane Review

KEY FINDINGS

• Small evidence base for PICO question and majority of studies are of low quality. Differing definitions and outcome measurements make comparing results across studies difficult.

• Guidelines did not recommend the implementation of psychological or psychosocial interventions for the prevention of perinatal mood disorders.

• The NICE guideline found no strong evidence that psychosocial and/or psychological interventions are effective to prevent the diagnosis of perinatal mood disorders in women.

• The Dennis Cochrane Review found a large (RR=0.5) beneficial effect of combined psychosocial and psychological interventions to prevent the diagnosis of postpartum depression compared to standard or routine care. However, this finding was based on 5 studies, most of low quality.

Lesson learned: It is easy to accept the conclusions of a systematic review authored by an expert in the field. However, critical appraisal is still important. Always look at the data presented.

APPLICABILITY AND TRANSFERABILITY

• Group discussion with Program Managers, Executive

representatives, EIDM Team members facilitated by Donna.

• Applied the A&T tool in a 2 hour meeting – group consensus

that the Rapid Review scored low on the tool (i.e. little impact).

• Actionable message: “No evidence to support a change in

practice with respect to public health’s role in preventing the

diagnosis of perinatal mood disorders”.

• Next steps:

Include the A&T activity as an appendix in the final report

Identify all target audiences and craft key messages.

Explore additional research questions that were not addressed by this

review.


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Presenters

Mary Guyton, RN, MEd

Sherbourne Health Centre Site

Heidi Parker, RN, MT

Sherbourne Health Centre Site

National Collaborating Centre for Methods and

Tools

Peer-to-Peer Webinar 3

Mary Guyton, RN, BScN, Med

Heidi Parker, RN, BScN, MT

Quality Improvement Project

to Build Best Practice Tool to

Address the Needs of Clients

with Hepatitis C

[email protected]

mailto:[email protected]

References

European Association for the Study of the Liver (EASL). (2016). EASL Recommendations on Treatment of Hepatitis C. Journal of Hepatology http://dx.doi.org/10.1016/j.jhep.2016.09.001

ASHM. (2016). Primary Care Providers and Hepatitis C. The Australian Government, Department of Health

Von Aesch, Z., Steele, L.S. & Shah, H. (2016). Primary care flow sheet for hepatitis C virus: tool for improved monitoring. Canadian Family Physician 62, p.384-92

Meyers, R.P., Shah, H., Burak, K.W., Cooper, C. & Feld, J.J. (2015). An update on the management of chronic hepatitis C: 2015 Consensus guidelines from the Canadian Association for the Study of the Liver. Can J Gastroenterol Hepatol 29(1).

Pinette, G.D., Cox, J.J., Heathcote, J., Moore, L., Adamowski, K. & Riehl G. (2009). Primary Care Management of Chronic Hepatitis C: A professional desk reference 2009. Public Health Agency of Canada (PHAC).

Plan-Do-Study-Act (PDSA) Worksheet (IHI tool). Institute for Healthcare Improvement. (November 10, 2016)

Ha, S., Totten, S., Pogany, L., Wu, J. & Gale-Rowe, M. (2016). Hepatitis C in Canada and the importance of risk-based screening. Can Comm Dis Rep 42, p57-62

Gastroenterological Society of Australia (GESA). (2016). Clinical Guidance for treating hepatitis C virus infection: a summary. Retrieved from: http://membes.gesa.org.au/membes/files/GP%20algorithm%20v3.pdf

http://dx.doi.org/10.1016/j.jhep.2016.09.001

http://membes.gesa.org.au/membes/files/GP algorithm v3.pdf


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EIDM Casebook Issue #2: Call for Abstracts

• We are looking for success stories in EIDM

• Submissions accepted until Friday, January 12,

2018

• For more information and abstract template,

please visit http://www.nccmt.ca/impact/user-

story/evidence-informed-decision-making-

casebook-project

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Funded by the Public Health Agency of Canada | Affiliated with McMaster UniversityProduction of this presentation has been made possible through a financial contribution from the Public Health Agency of Canada. The

views expressed here do not necessarily reflect the views of the Public Health Agency of Canada..

For more information about the National Collaborating Centre for Methods and Tools:NCCMT website www.nccmt.ca

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Peer-to-Peer Webinar Series: Success Stories in EIDM / Webinar #3