Clinical studies on depression do not address priority questions: a local basis exploration to guide research and funding in Chile.

Article type
Authors
Sánchez A1, Meza N2, Bracchiglione J2, Garnham R3, Dauvergne J4, Franco J5, Escobar-Liquitay C6, Madrid E2
1Pharmacy Unit, Libertador General Bernardo O'Higgins Regional Hospital, Rancagua, Chile; School of Medicine, University of Santiago de Chile, Chile
2Interdisciplinary Centre For Health Studies (ciesal), Universidad De Valparaíso, Viña Del Mar, Chile, Chile; Iberoamerican Cochrane Centre, Institut de Recerca Sant Pau (IR Sant Pau), CIBERESP, Barcelona, Spain
3Interdisciplinary Centre For Health Studies (ciesal), Universidad De Valparaíso, Viña Del Mar, Chile, Chile
4Facultad de Medicina, Universidad de Los Andes, Chile
5Institute of General Practice, Heinrich Heine University Düsseldorf, Germany
6Research Department, Cochrane Associate Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Argentina
Abstract
"Background: Depression is the third cause of the highest burden of disease in Chile, having financial coverage guaranteed by the health system. Therefore, it is necessary to plan and coordinate local research to improve clinical practice and health outcomes. However, there is no local diagnosis on whether Chilean clinical research explores relevant interventions and outcomes.
Objective: To characterise local clinical research on adult depression and generate an evidence map.
Methods: A scoping review of the Chilean literature on interventions for depression between 2000 and 2021 was performed. An evidence matrix was developed considering local clinical practice guidelines, and a core outcome set included by the COMET (Core Outcome Measures in Effectiveness Trials) initiative. Finally, the matrix was populated with the identified local studies, but also with systematic reviews retrieved regardless of geographical location, which have performed GRADE certainty of evidence assessment, in order to identify either true evidence gaps (TEG) or false evidence gaps (FEG) (further explanation in Table 1).
Preliminary results: Of the 12.124 studies selected, 6.160 studies have been preliminarily analysed, of which 69 are Chilean studies on depression in adults. Only 20 studies evaluated interventions. The most studied belong to the non-pharmacological group (n=12), psychotherapy (n=3), counselling (n=3), psychotherapy plus antidepressants (n= 2), and others not relevant (n=4). Response to treatment is the main outcome evaluated. The main local evidence gaps are circumscribed to the outcomes recurrence of depressive episodes, suicide, suicidal ideation and behaviour, and work productivity (Figure 1).
Conclusion: There is a strong contrast between the magnitude of the depression problem in Chile and the approach that local research has taken to evaluate the impact of existing interventions on our population. Mapping evidence gaps allows us to align future research and its funding with local evidence needs."