Psych Health Evidence Brief Methodology

Topic Nomination

Psych Health Evidence Brief topics include psychotherapeutic interventions for psychological health conditions of relevance to the active-duty population. Topic lists were generated for psychological health conditions for which a VA/DoD clinical practice guideline (CPG) exists, which includes major depressive disorder (MDD), posttraumatic stress disorder (PTSD), and substance use disorder (SUD)/alcohol use disorder (AUD), through a scan of systematic reviews of treatments for these disorders, as well as continuous scanning of topics covered in the media. These topic lists are updated regularly as new topics are identified. Additional topics, including those for psychological health conditions of relevance to the active-duty population that do not have VA/DoD CPGs, such as generalized anxiety disorder, will also be considered.

Drafting a Psych Health Evidence Brief

The following information breaks down the Psych Health Evidence Brief format into individual sections, explaining the methodology behind each section.

What is the intervention?

What is the treatment model underlying the intervention?

What are the potential mechanisms of action?

A brief overview of the intervention is provided, based on information from the appropriate VA/DoD CPG, literature reviews of the intervention and treatment manuals when available.

Is the intervention recommended in the Military Health System?

The appropriate VA/DoD CPG is consulted to see if that intervention is covered by the CPG. The brief explains whether the intervention is recommended in the CPG, including the grade[1] of the recommendation. The research review ends here for interventions that receive a “Strong” grade of recommendation, whether "Strong For" or "Strong Against," as the recommendation made by the CPG is based on an existing review of the evidence base and is unlikely to be affected by further research.

Do other authoritative reviews recommend this intervention as a treatment for this disorder?

Several other recognized organizations conduct systematic reviews and evidence syntheses on psychological health topics using similar grading systems as the VA/DoD CPGs. These include the Agency for Healthcare Research and Quality (AHRQ) Systematic Review Repository and the Cochrane Database of Systematic Reviews. Searches are conducted on the AHRQ and Cochrane websites for relevant reviews, and summaries of findings are provided in this section. Reports by other organizations may be included as needed, provided they follow a similar methodology.

Is there any recent research on this intervention as a treatment for this disorder?

For interventions that receive a “Weak” grade of recommendation, whether “Weak For” or “Weak Against,” this section will include a systematic literature search covering the time period since the literature review for the CPG was conducted. This section will highlight any important research that has emerged that was not taken into account by the CPG with a focus on RCTs and systematic reviews. For interventions that are not included in the CPG, a systematic literature search will be conducted to identify any existing RCTs and/or systematic reviews of the intervention.

What conclusions can be drawn about this intervention as a treatment for this disorder?

This section contains a summary of the VA/DoD CPG recommendation of the intervention, a summary of any literature that was identified, and a discussion of other factors that providers may take into account when considering the intervention.

Systematic Literature Search

Literature searches include the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE, using both free-text and controlled vocabulary.

The search strategy is informed by the main concepts of the Psych Health Evidence Brief, and include:

  1. Terms to search for the health condition of interest
  2. Terms to search for the intervention
  3. Terms to search for the types of study design to be included

To ensure a comprehensive search, a number of free-text terms are included for each of the main concepts. This includes synonyms, related terms, variant spellings, truncation, and wildcards. Field codes are used to specify the location of these terms. In addition to free-text terms, controlled vocabulary is used, when appropriate.

Search strategies for common conditions of interest (PTSD, MDD, AUD, and SUD) and randomized controlled trials were adapted from the Cochrane Common Mental Disorder’s ‘core search strategies,’ as well as search strategies from relevant, published Cochrane systematic reviews.

Strategies for other conditions and the intervention or treatment of interest will be created as needed using the above concepts.

Psych Health Evidence Brief Review Process

Each treatment brief is drafted by a masters’ level research associate and reviewed by at least one internal Ph.D.-level, subject matter expert.

References

[1]VA/DoD CPGs use the GRADE methodology to assign a grade for the strength for each recommendation. The grade of each recommendation is presented as part of a continuum, including “Strong For,” “Weak For,” “Weak Against,” and “Strong Against.” When it is determined that there is insufficient evidence to recommend for or against an intervention, a recommendation is “Not Applicable.” (See Andrews J, Guyatt G, Oxman AD, et al. Grade guidelines: 14. Going from evidence to recommendations: The significance and presentation of recommendations. J Clin Epidemiol. Jul 2013;66(7):719-725.).