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BMJ Open: first published as 10.1136/bmjopen-2017-019819 on 21 January 2018. Downloaded from BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. Whe a atile is pulished e post the pee eiees’ oets ad the authos’ esposes online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay- per-view fees (http://bmjopen.bmj.com). If you hae ay uestios o BMJ Ope’s ope pee eie poess please eail [email protected] http://bmjopen.bmj.com/ on September 30, 2021 by guest. Protected copyright. BMJ Open: first published as 10.1136/bmjopen-2017-019819 on 21 January 2018. Downloaded from BMJ Open Comparative efficacy and acceptability of interventions for major depression in older persons: protocol for Bayesian network meta-analysis ForJournal: peerBMJ Open review only Manuscript ID bmjopen-2017-019819 Article Type: rotocol Date Submitted by the Author: 27-Sep-2017 Complete List of Authors: Liew, Tau Ming* Institute of Mental Health, Department of ,eriatric sychiatry <b. rimary Subject Mental health Heading-/b. Secondary Subject Heading: ,eriatric medicine major depression, older person, efficacy, acceptability, networ1 meta- 0eywords: analysis http://bmjopen.bmj.com/ on September 30, 2021 by guest. Protected copyright. For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open: first published as 10.1136/bmjopen-2017-019819 on 21 January 2018. Downloaded from Page 1 of 21 BMJ Open 1 2 3 Comparative efficacy and acceptability of interventions for major depression in older 4 5 persons: protocol for Bayesian network meta-analysis 6 7 8 9 Tau Ming Liew1, 2 10 11 1Department of Geriatric Psychiatry, Institute of Mental Health, Singapore 12 13 2 14 Saw Swee Hoc School of Public Health, National University of Singapore, Singapore 15 16 For peer review only 17 18 19 20 Correspondence to 21 22 Tau Ming Liew% 23 24 tau_ming_liew'imh.com.sg 25 26 27 Department of Geriatric Psychiatry, Institute of Mental Health, 28 29 10 Buang o View, Singapore ,3.707. 30 31 http://bmjopen.bmj.com/ 32 33 Keywords: ma1or depression% older person% efficacy% acceptability% networ meta3analysis 34 35 36 37 Number of words (Abstract): 287 38 39 on September 30, 2021 by guest. Protected copyright. 40 Number of words (main te t): 2,00. 41 42 Number of references: 25 43 44 Number of tables or figures: 1 45 46 47 48 49 50 51 52 53 54 55 56 57 58 1 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open: first published as 10.1136/bmjopen-2017-019819 on 21 January 2018. Downloaded from BMJ Open Page 2 of 21 1 2 3 ABSTRACT 4 5 6 7 Introduction: Ma1or depression is a leading cause of disability, and has been associated with 8 9 adverse effects in older persons. 6hile many pharmacological and non3pharmacological 10 11 interventions have been shown to be effective to address ma1or depression in older persons, 12 13 14 there has not been a meta3analysis that consolidates all the available interventions and 15 16 compare the relativeFor benefits peer of these reviewavailable interventions. only In this study, we aim to 17 18 conduct a systematic review and networ meta3analysis to compare the efficacy and 19 20 acceptability of all the nown pharmacological and non3pharmacological interventions for 21 22 ma1or depression in older persons. 23 24 Methods and analysis: 6e will search PubMed, Embase, PsycIN8O, CINAHL, 6eb of 25 26 27 Science, Scopus, Cochrane Central Register of Controlled Trials and references of other 28 29 review articles for articles related to the eywords of ”randomized trial?, ”major depression? 30 31 and ”older persons?. Two reviewers will independently select the eligible articles. 8or each http://bmjopen.bmj.com/ 32 33 included article, the two reviewers will independently extract the data and assess the ris of 34 35 bias using the Cochrane ris of bias tool. Bayesian networ meta3analyses will be conducted 36 37 to pool the efficacy Abased on standardized mean difference of depression score) and all3 38 39 on September 30, 2021 by guest. Protected copyright. 40 cause attrition across all the included studies. The ran ing probabilities for all interventions 41 42 will be estimated and the hierarchy of each interventions will be summarized as surface under 43 44 the cumulative ran ing curve ASUCRA). Meta3regression and sub3group analyses will also 45 46 be performed to evaluate the effect of study3level covariates. The Cuality of the evidence will 47 48 be assessed using the Grading of Recommendations Assessment, Development and 49 50 Evaluation AGRADE) approach. 51 52 53 Ethics and dissemination: The results will be disseminated through conference 54 55 presentations and peer3reviewed publications. They will provide the consolidated evidence to 56 57 58 2 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open: first published as 10.1136/bmjopen-2017-019819 on 21 January 2018. Downloaded from Page 3 of 21 BMJ Open 1 2 3 inform clinicians on the best choice of intervention to address major depression in older 4 5 persons. 6 7 Trial registration number: International Prospective Register for Systematic Reviews 8 9 APROSPERO) temporary registration number 7,7,5 Asubmitted on 30th August 2017). 10 11 12 13 14 15 16 For peer review only 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 http://bmjopen.bmj.com/ 32 33 34 35 36 37 38 39 on September 30, 2021 by guest. Protected copyright. 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 3 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open: first published as 10.1136/bmjopen-2017-019819 on 21 January 2018. Downloaded from BMJ Open Page 4 of 21 1 2 3 STRENGTHS AND ,IMITATIONS O. THIS ST/D0 4 5 6 7 • This systematic review and meta3analysis will provide a comprehensive summary on the 8 9 efficacy and acceptability of all available interventions for ma1or depression in older 10 11 12 persons. 13 14 • The results will provide the highest level of evidence to inform clinicians on the best 15 16 choice of treatment,For peerfrom among review the many available only pharmacological and non3 17 18 pharmacological interventions. 19 20 • This protocol has been developed in accordance with the Preferred Reporting Items for 21 22 23 Systematic Review and Meta3analysis Protocols APRISMA3P) statement and has been 24 25 submitted for registration with PROSPERO. 26 27 • The overall Cuality of evidence will be assessed using the Grading of Recommendations 28 29 Assessment, Development and Evaluation AGRADE) approach. 30 http://bmjopen.bmj.com/ 31 • This systematic review will be limited to studies in English language. 32 33 34 35 36 37 38 39 on September 30, 2021 by guest. Protected copyright. 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 4 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open: first published as 10.1136/bmjopen-2017-019819 on 21 January 2018. Downloaded from Page 5 of 21 BMJ Open 1 2 3 INTROD/CTION 4 5 6 7 8 Rationale 9 10 11 12 13 Ma1or depression has been identified by the 6orld Health Organization as one of the leading 14 15 cause of disability globally.1 2 In older persons, its prevalence rates rise with the increase in 16 For peer review only 17 medical comorbidities,3 with reported rates of up to ,D in community3dwelling older 18 19 persons,33, , to 10D in primary care3 5 and as high as 37D after critical care hospitalizations.3 20 21 7 Ma1or depression has a significant impact on the older populations and has been lin ed to 22 23 0 8 . 0 10 24 higher ris of suicide, myocardial infarction, stro e, all3cause mortality and increasing 25 0 26 health services utilization. 27 28 29 30 A wide range of interventions have been available to treat ma1or depression in older persons. 31 http://bmjopen.bmj.com/ 32 These include pharmacological and non3pharmacological interventions such as 33 34 antidepressants,11 antipsychotics,12 cognitive behavioural therapy,13 problem solving 35 36 10 1, 15 37 therapy, family interventions and physical exercise. Some of these interventions also 38 11 39 have had recent meta3analyses confirming their efficacy when compared to control groups. on September 30, 2021 by guest. Protected copyright. 40 13 10 15 41 However, none of the meta3analyses had provided comparisons among all the 42 43 pharmacological and non3pharmacological interventions to demonstrate the relative benefits 44 45 of each intervention. It is un nown whether all the interventions have comparable efficacy 46 47 and are eCually suitable for older persons with ma1or depression. 48 49 50 51 52 Objectives 53 54 55 56 57 58 5 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open: first published as 10.1136/bmjopen-2017-019819 on 21 January 2018.
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