Evidence-based nursing in treatment of people with depression

This report, one in a series of publications on the topic of evidence-based nursing, was produced jointly by SBU and the Swedish Nurses Association (SSF). The series relates to the subject areas of SBU assessment reports and aims to present scientific evidence on the role of nursing in these contexts.

Evidence-based nursing has been a familiar concept internationally for several years. The application of evidence-based nursing involves using the findings from scientific studies to complement other knowledge for the purpose of delivering the best possible nursing care. These findings may be obtained from either quantitative and qualitative studies.

Obviously, evidence-based nursing does not provide all of the answers to the question of what constitutes good nursing care. Evidence from relevant research must be combined with knowledge about the needs and experiences of individual patients, and the specific situation itself.

The report shows, eg, that the body of scientific evidence is too limited to draw certain conclusions. Therefore, further research is needed in Sweden concerning the role and importance of the nurse in treating patients with depression.

Nevertheless, our hope is that this report will increase interest in research in the field, and that it will be used as educational material and a source of reference.

The report has not been reviewed by the SBU Board of Directors or the SBU Scientific Advisory Committee, nor by the Board of Directors of the Swedish Nurses Association. The authors alone are responsible for the content.

Summary and Proposed Research

This review and synthesis shows that there is very limited scientific evidence on the care of individuals with mood disorders and tendencies toward depression. Most studies do not directly address nursing, although they are relevant to nursing and its orientation.

The findings cover a selection of studies published from 1987 through 1998. The inclusion criteria used in the search strategy included "nursing" in combination with "mood disorders", "affective disorders", "depression", and "bipolar disorders", which probably limited the sample. The report includes only studies that were judged to be of high or moderate quality.

Since all studies were conducted in countries other than Sweden, and with other social and economic cultures, the value of the evidence may be difficult to apply to Swedish conditions. In most studies, adults with depression were treated. Only one study addressed children and adolescents, and one study addressed individuals with bipolar syndromes.

No studies were found on compulsory care in conjunction with psychotic conditions related to depression or mania, or studies which addressed ethical issues. Likewise, no studies were found concerning family members experiences in living with individuals with depression, or caregivers experiences and attitudes on caring for individuals with depression. Furthermore, no studies addressed cost-effectiveness and care organization related to the care of people with depression.

Only a few randomized studies (RCT) were found. Since these studies are recognized as having the highest scientific value when it comes to analyzing the effects of a particular intervention, it is essential that more studies become available. Mainly, the effects of different educational programs and different forms of support (eg, individual and group counseling and social training programs) should be assessed for both women and men. This is especially important since these program elements seem to play a particularly major and positive role in nursing care.

Another area which urgently needs to be addressed by rigorous nursing research concerns how families of depressed persons perceive their situation,how children of depressed family members perceive their situation, and the what type of nursing interventions are needed.