Clinical practice guideline recommendations to improve the mental health of adult trauma patients: protocol for a systematic review.

INTRODUCTION: Mental disorders are common in adult patients with traumatic injuries. To limit the burden of poor psychological well-being in this population, recognised authorities have issued recommendations through clinical practice guidelines (CPGs). However, the uptake of evidence-based recommendations to improve the mental health of trauma patients has been low until recently. This may be explained by the complexity of optimising mental health practices and interpretating CGPs scope and quality. Our aim is to systematically review CPG mental health recommendations in the context of trauma care and appraise their quality. METHODS AND ANALYSIS: We will identify CPG through a search strategy applied to Medline, Embase, CINAHL, PsycINFO and Web of Science databases, as well as guidelines repositories and websites of trauma associations. We will target CPGs on adult and acute trauma populations including at least one recommendation on any prevention, screening, assessment, intervention, patient and family engagement, referral or follow-up procedure related to mental health endorsed by recognised organisations in high-income countries. No language limitations will be applied, and we will limit the search to the last 15 years. Pairs of reviewers will independently screen titles, abstracts, full texts, and carry out data extraction and quality assessment of CPGs using the Appraisal of Guidelines Research and Evaluation (AGREE) II. We will synthesise the evidence on recommendations for CPGs rated as moderate or high quality using a matrix based on the Grading of Recommendations Assessment, Development and Evaluation quality of evidence, strength of recommendation, health and social determinants and whether recommendations were made using a population-based approach. ETHICS AND DISSEMINATION: Ethics approval is not required, as we will conduct secondary analysis of published data. The results will be disseminated in a peer-reviewed journal, at international and national scientific meetings. Accessible summary will be distributed to interested parties through professional, healthcare quality and persons with lived experience associations. PROSPERO REGISTRATION NUMBER: (ID454728).

[Short-term interventions offered by les centres locaux de services communautaires (CLSC) to people living with anxiety or depressive disorders: Results of the longitudinal component of the Shared Knowledge study]. / Les interventions de courte durée offertes par les centres locaux de services communautaires (CLSC) aux personnes traversant un épisode de troubles anxieux ou dépressifs : une étude longitudinale au Québec.

Context In Quebec, adult mental health (AMH) first-line teams are mandated to provide psychosocial services to people living with mental health difficulties, including anxiety and mood disorders. Following the establishment of new clinical guidelines in 2017, the duration of interventions was not to exceed 15 sessions, with some exceptions. Objectives The overall aim of the longitudinal component of the Shared Knowledge study was to evaluate the care experience of individuals with an anxiety or depressive disorder receiving a short-term intervention (<15 sessions) by first-line AMH teams, and the evolution of recovery over time. Specifically, the objectives were to: 1) determine the appreciation of short-term interventions by service users; and 2) assess the evolution over time of the symptomatology, functioning and quality of life and recovery of individuals receiving short-term interventions. Method A mixed method longitudinal design was used. Telephone interviews were conducted with participants, in which the following variables were quantitatively and qualitatively assessed: appreciation of services received, quality of relationship with the provider (INSPIRE), depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), global functioning (WHODAS), quality of life (ReQOL), and personal recovery (ERTAD). Linear mixed model analyses were performed to examine changes over time on quantitative measures. Content analysis was performed on the qualitative data. Results A total of 63 individuals participated in an interview before the start of their intervention and 22 of them participated after the end of this intervention. Statistical analyses showed a significant improvement in anxiety symptoms, quality of life, and personal recovery, but no difference was observed in depressive symptoms and level of functioning. Nearly half (47.4%) of participants reported that the intervention they received had "completely" met the need that had led them to seek help, and 33.3% felt "completely" equipped or empowered in their recovery. The quality of the relationship with the caregiver, the opportunity to take part in decision-making, and the personalization of the intervention according to their needs and preferences were some of the elements that were particularly appreciated. Conclusion Short-term interventions seem to be appreciated and produce positive effects in many people suffering from anxiety or depressive disorders. However, they remain insufficient for a number of them. A personal recovery measure should be used in conjunction with symptomatology and functioning scales to monitor the progress of people using first-line mental health services.