Universidade australiana lança coletânea sobre o diagnóstico e o manejo de condições de saúde mental relacionadas ao trabalho. As publicações visam subsidiar a atuação dos médicos generalistas.
Clinical guideline for the diagnosis and management of work-related mental health conditions in general practice (neste link, o guideline)
Work related mental health conditions are the second most common cause of workers’ compensation, however, these conditions are typically challenging to diagnose and treat. In Australia, most injured workers seek care from their general practitioner (GP).
The Clinical guideline for the diagnosis and management of work-related mental health conditions (the Guideline) has been developed to assist GPs with the diagnosis and management of work-related mental health conditions. The guideline recommendations were approved by the National Health and Medical Research Council (NHMRC) in late 2018. It is endorsed by the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM).
This work forms part of our program of compensable injury research. Documents developed as an outcome of this body of work include the full Guideline. This document provides detail about the guideline development process, a summary of the evidence for each topic, recommendations and consensus statements, and further information to consider when implementing the recommendations. A short form guideline has also been developed which lists the detailed recommendations and practice points derived from the Guideline, and lastly a two page GP summary which provides a snapshot of the recommendations and consensus statements in the Guideline. Documents can be accessed here:
Clinical guideline
Short form guideline
GP summary
Supplementary documents include:
Technical Report
Administrative Report
Combined Methodological & Expert Review Comments
Implementation and Dissemination Plan
Public Consultation Summary
Please note, hard copies of the guideline can be requested by contacting: generalpracticeguidelines@monash.edu
Vejam o sumário do relatório técnico que pode ser acessado aqui:
Clinical guideline for the diagnosis and management of work-related mental health conditions in general practice Technical Report
Table of Contents
1 Introduction .................................................................................................................................................. 1
Key Clinical Questions ...................................................................................................................................... 1
2 Methods used to develop evidence-based recommendations ........................................................................ 2
Literature search ............................................................................................................................................... 2
Appraising and summarising the evidence ....................................................................................................... 3
Data Analysis and Synthesis .............................................................................................................................. 4
Correction to “Work” Search Strategy in Embase, Medline, PsycINFO and AMED ..................................... 4
Grading the Evidence and Formulation of Recommendations ......................................................................... 7
3 Key clinical question one: In workers presenting with symptoms of mental health conditions, what tools
can assist a GP in making an accurate diagnosis and assessing severity of mental health conditions? ............. 8
Evidence Review Round One ........................................................................................................................... 8
Guideline Development Group recommendation ........................................................................................... 11
Evidence Review round two ............................................................................................................................ 11
Guideline Development Group recommendation ........................................................................................... 15
Identification of existing guidelines and systematic reviews for key clinical question 1 ................................ 15
Implications of correction to the “Work” Search String for Key clinical question 1 ...................................... 18
Guideline Development Group recommendation ........................................................................................... 19
Findings and GRADE Evidence Profile Tables from Evidence Review: Key clinical question 1 .................. 19
4 Key clinical question two: In workers, what factors assist in the early detection of a comorbid work-related
mental health condition? ................................................................................................................................. 27
Evidence Review round one ............................................................................................................................ 27
Guideline Development Group recommendation ........................................................................................... 29
Evidence Review round two ............................................................................................................................ 30
Guideline Development Group recommendation ........................................................................................... 32
Existing Guidelines and Systematic Reviews for Key clinical question 2 .................................................... 32
Implications of correction to the “Work” Search String for Key clinical question 2 .................................... 35
Guideline Development Group recommendation ........................................................................................... 36
Findings and GRADE Evidence Profile Tables from Evidence Reviews: Key clinical question 2 .............. 37
5 Key clinical question three: In patients with a diagnosed mental health condition, what methods are
effective at indicating the probability that the diagnosed mental health condition has arisen as a result of
work? ............................................................................................................................................................ 40
Evidence Review round one ............................................................................................................................ 40
Guideline Development Group recommendation ........................................................................................... 43
Evidence Review round two ............................................................................................................................ 43
Implications of correction to the “Work” Search String for Key clinical question 3 ..................................... 46
Guideline Evidence Review Technical Report ii
Guideline Development Group recommendation ........................................................................................... 47
Findings and GRADE Evidence Profile Tables from Evidence Reviews: Key clinical question 3 ............... 47
6 Key clinical question four: When conveying a diagnosis of a work-related mental health condition to a
patient, what factors should GPs consider, to ensure that their diagnosis is understood and acknowledged
by the patient? ............................................................................................................................................... 54
Evidence Review round one ............................................................................................................................ 54
Guideline Development Group recommendations ......................................................................................... 56
Evidence Review round two ............................................................................................................................ 56
Existing Guidelines and Systematic Reviews for Key clinical question 4 ..................................................... 57
Implications of correction to the “Work” Search String for Key clinical question 4........................................ 60
Guideline Development Group recommendation ........................................................................................... 61
Findings and GRADE Evidence Profile Tables from Evidence Reviews: Key clinical question 4 ............... 61
7 Key clinical question five: In patients with a work-related mental health condition, what GP strategies
result in the highest levels of personal recovery and/or return to work? ........................................................ 64
Evidence Review round one ............................................................................................................................ 64
Guideline Development Group recommendations ......................................................................................... 66
Evidence Review round two ............................................................................................................................ 66
Implications of correction to the “Work” Search String for Key clinical question 5 ..................................... 69
Guideline Development Group recommendation ........................................................................................... 70
Findings and GRADE Evidence Profile Tables from Evidence Reviews: Key clinical question 5 ............... 71
8 Key clinical question six: In workers with a mental health condition, what information should a GP
consider to determine whether a person has capacity to work? ..................................................................... 83
Evidence Review round one ............................................................................................................................ 83
Guideline Development Group recommendations ......................................................................................... 85
Evidence Review round two ............................................................................................................................ 85
Implications of correction to the “Work” Search String for Key clinical question 6........................................ 88
Guideline Development Group recommendation ........................................................................................... 89
Findings and GRADE Evidence Profile Tables from Evidence Reviews: Key clinical question 6 .............. 89
9 Key clinical question seven: What is appropriate communication with the patient’s workplace, in order to
appropriately manage a work-related mental health condition? ..................................................................... 94
Evidence Review round one ............................................................................................................................ 94
Guideline Development Group recommendations ......................................................................................... 96
Evidence Review round two ............................................................................................................................ 96
Existing Guidelines and Systematic Reviews for Key clinical question 7 ...................................................... 98
Implications of correction to the “Work” Search String for Key clinical question 7 ................................... 102
Guideline Development Group recommendation ......................................................................................... 102
Findings and GRADE Evidence Profile Tables from Evidence Reviews: Key clinical question 7 . ........... 103
Guideline Evidence Review Technical Report iii
10 Key clinical question eight: In patients with work-related mental health conditions, what interventions
are effective at managing comorbid substance misuse and addictive disorders by GPs? ............................ 107
Evidence Review round one .......................................................................................................................... 107
Guideline Development Group recommendations ....................................................................................... 109
Evidence Review round two .......................................................................................................................... 109
Existing Guidelines and Systematic Reviews for key clinical question 8.....................................................111
Implications of correction to the “Work” Search String for Key clinical question 8...................................... 115
Recommendations arising from the Guideline Development Group meeting ............................................. 115
Findings and GRADE Evidence Profile Tables from Evidence Reviews: Key clinical question 8 ............. 115
11 Key clinical question nine: In patients with a diagnosis of a work-related mental health condition, what
factors adversely affect progress in the patient’s condition? ........................................................................ 118
Evidence Review round one .......................................................................................................................... 118
Guideline Development Group recommendations ....................................................................................... 120
Evidence Review round two .......................................................................................................................... 120
Implications of correction to the “Work” Search String for Key clinical question 9...................................... 123
Guideline Development Group recommendation ......................................................................................... 124
Findings and GRADE Evidence Profile Tables from Evidence Reviews: Key clinical question 9 ............. 124
12 Key clinical question ten: In patients with work-related mental health conditions who are not improving,
what strategies should a general practitioner undertake to improve the patient’s condition? ...................... 128
Evidence Review round one .......................................................................................................................... 128
Guideline Development Group recommendations ....................................................................................... 130
Evidence Review round two .......................................................................................................................... 130
Implications of correction to the “Work” Search String for Key clinical question 10 ................................. 132
Guideline Development Group recommendation ......................................................................................... 133
Findings and GRADE Evidence Profile Tables from Evidence Review: Key clinical question 10 ..............135
13 Appendices ............................................................................................................................................. 139
Appendix 1 Quality Assessment of Diagnostic Accuracy Studies (QUADAS) Checklist ........................ 139
Appendix 2 NHMRC Technical Report Requirements Checklist ................................................................140
14 References ................................................................................................................................................142
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