Examining the description of the concept “treatment as usual” for patients with depression, anxiety and stress-related mental disorders in primary health care research – A systematic review

• Published in: Journal of affective disorders 2023-04, Vol.326, p.1-10
• Main Authors: Petersson, E-L., Forsén, E., Björkelund, C., Hammarbäck, L., Hessman, E., Weineland, S., Svenningsson, I.
• Format: Article
• Language: English
• Subjects: Anxiety; Anxiety - therapy; Anxiety Disorders - therapy; Clinical Medicine; Depression; Depression - therapy; Health Services Research; Humans; Klinisk medicin; Methodology; Primary care; Psychology; Psykologi; Stress-related disorder; Treatment as usual
• ISSN: 0165-0327; 1573-2517; 1573-2517
• DOI: 10.1016/j.jad.2023.01.076

In randomized controlled trials (RCTs) within medical research, applied interventions are compared to treatment-as-usual (TAU) as the control condition. The aim of the current study was to examine how the concept of TAU is described when used as control condition in RCTs evaluating treatments for depression, anxiety syndromes, and stress-related mental disorders in primary care. A systematic review of RCTs utilizing TAU as control group in the RCT in accordance with PRISMA standards was conducted. We used one multidisciplinary database (Scopus), one database focused on nursing (Cinahl), and one medical database (PubMed). The searches were conducted in November 2021 and May 2022. The included 32 studies comprised of 7803 participants. The content of TAU was classified as follows: 1) Basic descriptions of TAU lacking a detailed account as well as reference to local or national guidelines, 2) Moderate description of TAU including reference to national or local guidelines or a detailed description 3) Advanced description of TAU including references to national guidelines and a detailed description containing five key concepts: early assessment, accessibility, psychological treatment, medication, somatic examination. 18 studies had basic, 11 moderate, and 3 advanced descriptions of TAU. The limitations were that only studies published in English were included. The current study provides an assessment tool with three classification levels for TAU. The description of TAU is still insufficient in RCT studies conducted in primary care, which may affect the interpretation of results. In future research a detailed description of TAU is recommended. •The description of TAU is still insufficient in RCT studies conducted in primary care.•The insufficient description of TAU may affect the interpretation of results.•The current study provides an assessment tool with three classification levels for TAU.•In future research a detailed description of TAU is recommended.•Studies on stress-related mental disorders and the description of TAU are lacking.