Core Principles of Mental Health Research Literature Reviews PDF

**[Core Principles of Mental Health Research]** **[Literature Reviews ]** [Why review the literature:] - Makes the evidence accessible - Allows assessment of what is known and not known overall on a topic - Can guide clinical decision making and the formulation of guidelines - If combi...

**[Core Principles of Mental Health Research]** **[Literature Reviews ]** [Why review the literature:] - Makes the evidence accessible - Allows assessment of what is known and not known overall on a topic - Can guide clinical decision making and the formulation of guidelines - If combining the data is possible (meta-analysis), can result in much more powerful analysis than any single study [What is a systematic review?] - Reports a comprehensive and reproducible search - Exhaustive steps to trace all relevant evidence - Developed as a means of synthesising randomised controlled trial evidence - Now systematic reviews not just RCTs -- all types of data, including recently qualitative - Has a methods section which allows full replication of review methods [Content of a systematic review:] Included in methods section: - Scope of search: database, years, languages, types of paper - Search terms - Inclusion and exclusion criteria for papers to be reported in review - Data to be extracted from each paper - How studies to be appraised -- tools for quality rating often used PRISMA guidelines -- specify how systematic reviews should be reported [Meta-analysis:] - Statistical pooling of results from different, but similar results - Often results in much greater statistical power than original studies - Modern meta-analyses -- assess both the pooled result and its significance, and the extent of variation between the studies - Central to clinical guidelines e.g., NICE [Advantages of systematic reviews and meta-analyses:] - Comprehensive data search and systematic extraction avoids: - Subjectivity - Significant evidence being missed - When data can be aggregated, pooling evidence makes overall finding clearer (meta-analysis) - Clear positive finding from substantial and good quality meta-analysis can be seen as good support for a treatment [Systematic Review Limitations:] - Publication bias: - Negative findings less often published - Key stakeholders have an interest in not publishing - Around 50% trials currently not published - Initiatives to increase publication: trial registries, requirements to publish within a year, - Data invisibility even higher for other types of study - Restricted search strategies, especially regarding language - Positive findings more likely to be published in English - Quickly out of date - Analyses that are wrong or even fraudulent, data manipulation - Trial registration & making data available - Studies included may vary greatly in time, culture, type of intervention: - E.g., Cochrane review of crisis intervention for severely ill: - Publication dates range from 1964 to 2010 - Experimental conditions range from weekly visits to twice daily intensive support or crisis house; - Control conditions range from asylum to community - Negative conclusions may mean: - Treatment doesn't work or - Evidence doesn't show an effect due to small overall numbers or poor quality of studies - Important effects may not be measured e.g., companionship from peer support [Steps in designing systematic review:] 1. Define a review question -- as precise as possible 2. Consider PRISMA guidelines for reporting and consider talking to a librarian/information technologist 3. Define inclusion and exclusion criteria for selecting studies for the review, considering PICOS: a. Population: which types of research participant will be included b. Intervention: which types of experimental intervention c. Comparator: which types of control group d. Outcomes: which types of outcome e. Study design: which types of study design 4. Specify sources to be searched and language and date ranges f. Bibliographical databases g. Grey literature h. Research registries, searching reference lists, contact with authors 5. Design search strategy 6. Decide on process for screening papers: i. Titles and abstracts first j. Then full papers for potentially relevant studies k. Multiple raters if possible -- second ratings at each stage for at least a proportion 7. Specify what data will be extracted 8. Decide how to store and process data 9. Decide how to synthesise studies l. Is meta-analysis possible (consider similarity of studies) m. How will you summarise papers found if not? 10. Register protocol: PROSPERO [PICOS Criteria:] - Population - Interventions - Comparators - Outcomes - Study design [Key sources for systematic reviews:] - Centre for Reviews and Dissemination, York -- Prospero - Cochrane database of systematic reviews -- largest source of reviews in healthcare, standard procedures for all aspects of review - Campbell collaboration -- reviews relevant to public policy [Beyond systematic reviews:] - Scoping review: broad review aimed at mapping out what the literature in a particular area looks like - E.g., using technology to deliver mental health services to children and youth - Qualitative reviews: methods now developed for synthesis of qualitative literature - E.g., patients experiences of assessment and detention under mental health legislation - Umbrella review: systematic review, good for getting a handle on a large body of literature on a question quickly - E.g., preventative interventions for psychosis [Developing a search strategy:] The research questions informs the search strategy: - Choice of databases - Choice of search terms - Search limits Be over-inclusive rather than under-inclusive in your search [Prisma Guidelines:] - Prisma provides internationally recognised standards for conducting and reporting systematic reviews The Prisma checklist is a helpful prompt re decisions you need to make for your systematic review, including: - Research question - Study eligibility criteria (PICOS) - Information forces (which databases) - Search terms - Study selection - Data extraction process - Risk of bias/quality assessment [Useful databases for mental health research:] - Medline/pubmed (biomedicine & health) - Web of science (broad range of bioscience) - Embase (biomedicine & pharmaceutical) - PsycINFO (psychology) - CINAHL (nursing and allied health) - Cochrane [Grey Literature:] There may be other relevant literature not retrieved through searches of electronic databases: - PhD theses - Conference Proceedings - Government or expert bodies guidelines - Surveys/reports from campaigning organisations [Defining your search terms:] - Identify the main concepts within your research question - Identify all key terms within each concept - Use inverted commas to search for whole phrases only - Use truncation in order to include various spellings of the world - Combine terms for each concept using "booleian operators" [Subject terms and text words:] - Many databases use standardised subject terms as part of a controlled vocabulary - Assigned by indexers - Used to identify articles that relate to the same construct, but use different descriptors - E.g., self-harm, deliberate self-harm, self-injurious behaviour - Can be useful in finding articles that use alternative, unusual, or different terminology Some problems: - Subject terms differ across databases - Subject terms not available for all search terms - Incorrect indexing due to poor description of methods, populations or interventions in article - Indexing is relatively new: some older articles will not have been assigned subject terms [Combining Searched: Boolean operators: ] - And (middle section of Venn) - OR (entirety if Venn) - Not (one Venn without the intersecting) Using And produces a smaller, more focused set of results (use to combine different concepts in a search) Using OR produces a larger set of results (use to combine similar terms Use NOT to exclude articles including the second keyword [Search Limits:] - Setting limits can make your searching more precise - Publication dates - Language of paper - Type of study - Search limits must have a clear rationale [Demonstration:] - Accessing UCL databases - Setting up a multi-database search with OVID - Select multi-field search - Searching MeSH terms and aubject terms - Setting search limits - Deduplicating [Search Strategy:] - Databases Search Terms: 1. Young people or teenager or youth or adolescent or young adult or children 2. Help-seeking or help seek or help or seek treatment or help seeking 3. Mental disorder or depression or anxiety or psychiatric Limits: - Human and English language - Once you've conducted the 3 separate searches apply Boolean logic (combine them with AND) - Deduplicate (option only available if you have less than 6000 records) [Post Search:] - Screen citations identified for relevance to the review questions - Full manuscripts need to be obtained for potentially all relevant studies - Sift through the papers to decide on whether to include these in the review or exclude them - Done based on explicit study selection criteria - Independent reviewer should cross-check articles - Quality appraisal of articles [Data Extraction:] - Synthesising relevant information from the paper into tables - Information that you include in the table will vary depending on your research question May consider: - Information about the study reference and reviewer - Verification of study eligibility - Study characteristics - Research methods - Participants - Interventions - Outcome measures - Results [Critical appraisal tools/Risk of bias tools:] - Checking the quality of the papers included in your systematic review (trustworthiness, relevance, believable, useful) - Identify any threats to validity of the findings - Different tools for different study designs - May choose not to do one e.g., if the field is in its infancy -- if not justify [Examples of different types of critical appraisal tools available:] - RCTs - Cochrane Risk of Bias Tool - Case control/Observational studies - ROBINS-I or ROBINS-E (risk of bias for non-randomised (observational) studies of cohorts of interventions/exposure - NOS (Newcastle Ottawa Scale) - Qualitative Studies - Joanna Briggs Checklist for Qualitative Research - Cross-Sectional Studies - AXIS - Mixed Methods - MMAT - CASP - CEBM - Systematic Reviews - AMSTAR