gms | German Medical Science

Background: Due to its high lifetime prevalence and the medical and social consequences for the patients affected, depression accounts for an enormous burden of disease associated with high socioeconomic costs. Especially patients with a severe depression who require inpatient treatment constitute a vulnerable group. After discharge from inpatient mental health care, transition into ambulatory treatment is often hampered by sectoral separation and lack of cooperation between hospital and subsequent care providers (primary care, psychiatrists, psychologists etc.). Interventions aimed at making transition more smooth and ensuring continuity of care are diverse and complex and have not been systematically reviewed to date.

Study questions: Which discharge management strategies and post-discharge care interventions are beneficial (or harmful) for patients with depression discharged from inpatient care?

Specifically: how do such interventions and strategies compare to a) no intervention / usual care or b) other experimental interventions in regard to patient-relevant outcomes, among them readmissions and mental health?

Methods: A systematic review of RCTs and controlled trials is conducted. After finalizing the study protocol and PROSPERO registration (CRD42015026493), an electronic database search in MEDLINE, EMBASE, PsycINFO, PSYNDEXplus and the Cochrane Library has been recently concluded. The title, abstract and full-text screening process and the quality appraisal step – executed by two reviewers independently – are expected to be completed by the time of presentation. Data analysis and interpretation will be guided by a systematic framework designed a priori. Subject to the condition of adequate data quality, we aim to statistically pool study results by random-effects meta-analysis. Funding is provided by the Federal Ministry of Education and Research (BMBF).

Results: We will present details of the study protocol, the electronic search strategy, results of the electronic database search and a preliminary pool of studies identified for inclusion. Particular focus will be given to the methodological challenges in a review evaluating complex multifaceted interventions in health services research.

Conclusion: The identification of evidence-based interventions (or components thereof) in post-discharge care for depression is expected to prove valuable for the future planning of optimized care transition processes.