Depression and obesity will be first topics of APA clinical treatment guidelines

Guidelines to cover entire lifespan

By Howard Kurtzman, PhD and Lynn Bufka, PhD

September 15, 2011 — The topics of the first two clinical treatment guidelines to be developed by the American Psychological Association (APA) will be depressive disorders and obesity. The steering committee that is managing APA’s treatment guidelines effort made this decision at its meeting on August 12-14, 2011, in Washington, DC. The committee then informed the APA Board of Directors and other APA governance groups that are overseeing its work of the decision and its rationale. (See previous coverage of the mission and activities of the APA treatment guidelines steering committee.)

The committee arrived at its decision following a lengthy review process. After examining various disorders and conditions (both mental and physical) as potential guideline topics over the preceding months, the committee narrowed the focus at its August meeting to four: depressive disorders, obesity, oppositional-defiant disorder and post-traumatic stress disorder. The committee organized assessments and discussion of each of these topics around six criteria: 

  1. Appropriateness of the topic for psychologists 

  2. Importance of the topic (including such factors as prevalence, symptom severity and burden) 

  3. Need for a treatment guideline for the topic 

  4. Value of a treatment guideline for the topic (such as the impact the guideline would have beyond other available materials on the topic) 

  5. Quantity of evidence that would support a treatment guideline for the topic 

  6. Feasibility of developing a treatment guideline for the topic

In the end, the committee decided unanimously that all four topics were worthy of guideline development but that depressive disorders and obesity ranked somewhat higher. The committee also concluded that the guidelines for both depressive disorders and obesity should cover the entire lifespan (including children and older adults), although it expects that these guidelines will contain treatment recommendations that are age-specific.

The full scope of each guideline (such as whether the depressive disorders guideline should include bipolar disorder) will be determined at a future stage jointly by the steering committee and the panel that is appointed to develop the guideline. However, the steering committee did specify that the depressive disorders guideline should consider both psychosocial and psychopharmacological treatments.

The committee will consider post-traumatic stress disorder and oppositional-defiant disorder in future years as possible topics for treatment guidelines. It also plans to invite the psychological community to submit other topics to be considered along with those topics. The call for submissions of additional topics will likely be made in 2012.

As currently anticipated, APA will provide funding over three years (2012-2014) for the development of three guidelines. It is estimated that each guideline will take 18-24 months to complete. At the end of the three-year period, an evaluation of the treatment guidelines project will be conducted and the Board of Directors will make a decision about whether and how to continue it.

As in all its meetings, the steering committee took steps at its August meeting to identify and address any potential financial and non-financial conflicts of interest. Although no members had financial conflicts of interest related to any of the four final topics, some members did have a history of research or clinical work on particular topics that could be perceived as creating an “intellectual” conflict of interest. Those members recused themselves from the bulk of the final discussions of those topics.

Guideline development panels to be formed

The next step is the establishment of guideline development panels for each topic. These panels will work with the steering committee to formulate questions that will drive systematic reviews of the research literature and will take the lead roles in producing guidelines on the basis of these systematic reviews. The call for nominations for the guideline development panel for depressive disorders has been released (with a deadline of November 15, 2011), and the call for nominations for the obesity panel will be released in early 2012.

The depressive disorders panel will comprise at least seven members, including at least three experts in depressive disorders, one full-time practitioner, one patient/consumer advocate and one biostatistician or methodologist. A broad range of perspectives and experience is sought for the panel, and it is expected that the panel will include one or more members from disciplines other than psychology.

Systematic reviews involve exhaustive and well-documented searches, assessments and syntheses of the research literature on a specific issue. Care is taken to identify biases or methodological limitations in each available study. Systematic reviews of the literature on treatments typically follow the “PICOT” model, such that each study is characterized in terms of specific populations, interventions, comparisons, outcomes and timelines.

This approach to systematic reviews enables the guidelines that are ultimately developed to indicate the strength of the evidence for each treatment across particular clinical situations. The guidelines will also acknowledge that a lack of research on a particular treatment does not imply that the treatment lacks effectiveness. In fact, systematic reviews can serve to expose gaps in the current literature and encourage research in new areas. New research can be incorporated into future revisions of treatment guidelines.

Although the treatment guideline development panels and steering committee will formulate the questions for the systematic reviews, they will not conduct the reviews themselves. Those will be conducted independently, either by an outside organization or by a separate office that would be created within APA. In some cases, systematic reviews that have already been produced by other groups can be used or built upon.

At its next meeting in October, the steering committee will weigh the options for how the systematic reviews for depressive disorders and obesity should be conducted. It will also discuss the specific format for treatment guidelines, in order both to provide direction to the development panels and to help guide the formulation of systematic review questions. The Institute of Medicine’s recent standards for systematic reviews and guidelines will shape the committee’s approach.

A website with information and documents related to the steering committee’s work is under development. Questions and comments can be directed now to APA’s Clinical Treatment Guidelines email.

See also: Call for Nominations: Clinical Treatment Guideline Development Panel — Depressive Disorders Across the Lifespan (deadline: Nov. 15, 2011)

Howard Kurtzman, PhD, is deputy executive director for science (Science Directorate) and Lynn Bufka, PhD, is assistant executive director for practice research and policy (Practice Directorate) at the American Psychological Association. This article is appearing in both Psychological Science Agenda and PracticeUpdate.