What outcomes matter to service users who experience persistent depression: A mixed-method narrative review and synthesis

Background: It is unclear whether current outcome measures capture what is important to service users experiencing treatment-resistant depression (TRD). This review aims to understand what outcomes are important to people receiving treatment for TRD, and to ascertain how this is being measured or could be measured to aid values-based commissioning in the implementation of specialist services. Methods: A systematic search was conducted across nine databases: EMBASE, PSychINFO, AMED, EMCARE, PubMed, BNI, HMIC, CINHAL, and Medline. Quantitative and qualitative studies, and non-empirical work were included. No publication date restrictions were set. Included studies were appraised for quality. Results: Twenty-two studies met inclusion for the review, including two opinion pieces. Thematic analysis was used to extract five themes: important outcomes beyond recovery from symptoms; differentiations in perspectives; patient preferences; essential sets of outcome measures; and underdeveloped outcome measures from the patient's perspective. Limitations: The search strategy was partially systematic due to the exploratory nature of the subject and the lack of available research in the field. Studies included collect data on patient perspectives but did not demonstrate co-production throughout the whole research process. Conclusions: Outcomes in persistent depression have been neglected, especially from the patient perspective. The findings from this review make an important contribution to agreeing desirable outcomes for people with TRD by drawing together the literature and highlighting how and why it is necessary to apply certain methods to persistent depression. The report identifies areas where further understanding and research is needed and how to inform current service commissioning practices

Cultural Resource Survey of the United States Naval Academy Annapolis, Maryland

This report presents the results of the Legacy Resource Management Program, Cultural Resource Management survey as it relates to the United States Naval Academy (USNA) in Annapolis, Maryland. Sponsored by the United States Department of Defense and managed through the Naval Facilities (CHESDIV), a multi-faceted project was initiated by Archaeology In Annapolis, an on-going research project jointly sponsored by Historic Annapolis Foundation, and the University of Maryland, College Park. The project was comprised of an archaeological survey conducted over a 2 month period, title searches on properties now occupied by the USNA, oral history interviews conducted with residents of a former neighborhood purchased by the Academy, and the use of the AutoCAD computer mapping program to assist with the archaeological survey and to potentially generate a predictive model of where historic or prehistoric cultural resources may exist on USNA property. Conclusions drawn from this study highlight the rich amount of cultural resources which exist in the form of artifacts dating from the late-1700's, deeds information that shows changing economic and social patterns throughout the 290 year history of the ground occupied by the Academy, memories of individuals who lived through the expansion of the Academy into their homes, and a series of maps which can be used to indicate the likelihood of further cultural resources

Economic evaluation of interventions for treatment-resistant depression: a systematic review.

Peer reviewed: TrueAcknowledgements: We would like to thank Professor Jennifer Whitty, Honorary Professorial Fellow at Norwich Medical School, and Senior Research Scientist at Evidera for her role in designing the research programme this review belongs to, and guiding development of the original protocol.Background: The extraordinarily high prevalence of treatment-resistant depression (TRD), coupled with its high economic burden to both healthcare systems and society, underscore how critical it is that resources are managed optimally to address the significant challenge it presents. Objective: To review the literature on economic evaluation in TRD systematically, with the aim of informing future studies by identifying key challenges specific to the area, and highlighting good practices. Methods: A systematic literature search across seven electronic databases was conducted to identify both within-trial and model-based economic evaluations in TRD. Quality of reporting and study design was assessed using the Consensus Health Economic Criteria (CHEC). A narrative synthesis was conducted. Results: We identified 31 evaluations, including 11 conducted alongside a clinical trial and 20 model-based evaluations. There was considerable heterogeneity in the definition of treatment-resistant depression, although with a trend for more recent studies to use a definition of inadequate response to two or more antidepressive treatments. A broad range of interventions were considered, including non-pharmacological neuromodulation, pharmacological, psychological, and service-level interventions. Study quality as assessed by CHEC was generally high. Frequently poorly reported items related to discussion of ethical and distributional issues, and model validation. Most evaluations considered comparable core clinical outcomes – encompassing remission, response, and relapse. There was good agreement on the definitions and thresholds for these outcomes, and a relatively small pool of outcome measures were used. Resource criteria used to inform the estimation of direct costs, were reasonably uniform. Predominantly, however, there was a high level of heterogeneity in terms of evaluation design and sophistication, quality of evidence used (particularly health state utility data), time horizon, population considered, and cost perspective. Conclusion: Economic evidence for interventions in TRD is underdeveloped, particularly so for service-level interventions. Where evidence does exist, it is hampered by inconsistency in study design, methodological quality, and availability of high quality long-term outcomes evidence. This review identifies a number of key considerations and challenges for the design of future economic evaluations. Recommendations for research and suggestions for good practice are made. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=259848&VersionID=1542096, identifier CRD42021259848.This study was supported by a Medical Education Grant from Janssen Pharmaceutical Companies of Johnson & Johnson [Medical Educational Goods and Services (MEGS) Agreement reference EM-31940], by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration East of England (NIHR ARC EoE) at Cambridgeshire and Peterborough NHS Foundation Trust, and by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014). RNC’s research was supported by the UK Medical Research Council (MR/W014386/1). The funders had no role in the design, review, interpretation, writing of the report, or the decision to submit it for publication

Economic evaluation of interventions for treatment-resistant depression: a systematic review.

Background: The extraordinarily high prevalence of treatment-resistant depression (TRD), coupled with its high economic burden to both healthcare systems and society, underscore how critical it is that resources are managed optimally to address the significant challenge it presents. Objective: To review the literature on economic evaluation in TRD systematically, with the aim of informing future studies by identifying key challenges specific to the area, and highlighting good practices. Methods: A systematic literature search across seven electronic databases was conducted to identify both within-trial and model-based economic evaluations in TRD. Quality of reporting and study design was assessed using the Consensus Health Economic Criteria (CHEC). A narrative synthesis was conducted. Results: We identified 31 evaluations, including 11 conducted alongside a clinical trial and 20 model-based evaluations. There was considerable heterogeneity in the definition of treatment-resistant depression, although with a trend for more recent studies to use a definition of inadequate response to two or more antidepressive treatments. A broad range of interventions were considered, including non-pharmacological neuromodulation, pharmacological, psychological, and service-level interventions. Study quality as assessed by CHEC was generally high. Frequently poorly reported items related to discussion of ethical and distributional issues, and model validation. Most evaluations considered comparable core clinical outcomes – encompassing remission, response, and relapse. There was good agreement on the definitions and thresholds for these outcomes, and a relatively small pool of outcome measures were used. Resource criteria used to inform the estimation of direct costs, were reasonably uniform. Predominantly, however, there was a high level of heterogeneity in terms of evaluation design and sophistication, quality of evidence used (particularly health state utility data), time horizon, population considered, and cost perspective. Conclusion: Economic evidence for interventions in TRD is underdeveloped, particularly so for service-level interventions. Where evidence does exist, it is hampered by inconsistency in study design, methodological quality, and availability of high quality long-term outcomes evidence. This review identifies a number of key considerations and challenges for the design of future economic evaluations. Recommendations for research and suggestions for good practice are made. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=259848&VersionID=1542096, identifier CRD42021259848.This study was supported by a Medical Education Grant from Janssen Pharmaceutical Companies of Johnson & Johnson [Medical Educational Goods and Services (MEGS) Agreement reference EM-31940], by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration East of England (NIHR ARC EoE) at Cambridgeshire and Peterborough NHS Foundation Trust, and by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014). RNC’s research was supported by the UK Medical Research Council (MR/W014386/1). The funders had no role in the design, review, interpretation, writing of the report, or the decision to submit it for publication

Economic evaluation of interventions for treatment-resistant depression: A systematic review

Background: The extraordinarily high prevalence of treatment-resistant depression (TRD), coupled with its high economic burden to both healthcare systems and society, underscore how critical it is that resources are managed optimally to address the significant challenge it presents. Objective: To review the literature on economic evaluation in TRD systematically, with the aim of informing future studies by identifying key challenges specific to the area, and highlighting good practices. Methods: A systematic literature search across seven electronic databases was conducted to identify both within-trial and model-based economic evaluations in TRD. Quality of reporting and study design was assessed using the Consensus Health Economic Criteria (CHEC). A narrative synthesis was conducted. Results: We identified 31 evaluations, including 11 conducted alongside a clinical trial and 20 model-based evaluations. There was considerable heterogeneity in the definition of treatment-resistant depression, although with a trend for more recent studies to use a definition of inadequate response to two or more antidepressive treatments. A broad range of interventions were considered, including non-pharmacological neuromodulation, pharmacological, psychological, and service-level interventions. Study quality as assessed by CHEC was generally high. Frequently poorly reported items related to discussion of ethical and distributional issues, and model validation. Most evaluations considered comparable core clinical outcomes – encompassing remission, response, and relapse. There was good agreement on the definitions and thresholds for these outcomes, and a relatively small pool of outcome measures were used. Resource criteria used to inform the estimation of direct costs, were reasonably uniform. Predominantly, however, there was a high level of heterogeneity in terms of evaluation design and sophistication, quality of evidence used (particularly health state utility data), time horizon, population considered, and cost perspective. Conclusion: Economic evidence for interventions in TRD is underdeveloped, particularly so for service-level interventions. Where evidence does exist, it is hampered by inconsistency in study design, methodological quality, and availability of high quality long-term outcomes evidence. This review identifies a number of key considerations and challenges for the design of future economic evaluations. Recommendations for research and suggestions for good practice are made. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=259848&VersionID=1542096, identifier CRD42021259848