(i-VALiD) Informing VALues-based practice in Depression

The i-VALid project endeavours to improve care pathways for depression and treatment-resistant depression (TRD) by creating a comprehensive evidence base that incorporates patient values, the best available evidence, and clinical expertise.

Background

Depression is a leading cause of global disability and affects millions of adults worldwide. The disorder is managed across diverse settings and specialities, including primary care and secondary care, where treatment is received from a range of healthcare professionals. However, approximately 30% do not report full remission after receiving first- and second-line treatments, and continue to suffer debilitating chronic depression. Those who experience treatment-resistant depression (TRD), most widely defined as failure to respond to two or more antidepressant therapies at an appropriate dose and for an appropriate duration, often require long-term input from secondary mental health services. 

The National Institute for Health and Care Excellence (NICE) recommends a stepped care and collaborative treatment model, emphasizing care that progressively adjusts to individuals' needs and offers easy access to effective treatments. Despite NICE guidance and evidence to support the effectiveness of treatments, studies reveal many patients are not receiving care according to treatment guidelines.

To date, there has been limited research identifying and exploring care pathways for depression and TRD, contributing to the burden experienced by patients. The i-VALID project aims to address this gap by providing evidence-based recommendations to inform the development of improved care pathways for depression and TRD. The project will strive to accomplish this goal by employing "values-based practice” an approach that draws together best available evidence, clinical expertise, and patient/carer priorities.

Project Aims

  • Supported the development of an evidenced based pathway for depression and TRD that integrates best evidence, clinical expertise, and patient/carer values.
  • Examined the treatment pathway and risk factors for depression and TRD, across primary and secondary care services.
  • Better understood how current resources are being used, and how to optimise care, by identifying key intervention points and tailoring future interventions.

Project Activity

The first phase included two systematic reviews, the first looking at outcomes that matter to patients and the second, economic evaluations of interventions for TRD.

The next phase of the project used real-world data to map and analyse the care pathway, risk factors, and interventions for depression and TRD. The research team used de-identified electronic health records from secondary care NHS services and used epidemiological methods to explore themes of: patient cohort, diagnostic variation, comorbidities, and treatment management. Data were used to identify areas for improvement.

Outputs

This project has two published papers:

  • The first paper explored 'What outcomes matter to service users who experience persistent depression: A mixed-method narrative review and synthesis.' This project included Laura Hannah, Katherine Cummergen, Louise Jopling, Rory Cameron, Cathy Walsh and Jesus Perez.
  • The second paper is an 'Economic evaluations of interventions for treatment-resistant depression: a systematic review.' This project involved Laura Hannah, Cathy Walsh, Louise Jopling, Jesus Perez, Rudolf Cardinal, and Rory Cameron.
  • A further study is available as a preprint (https://doi.org/10.1101/2025.07.15.25331272): "Characterising the depression pathway in secondary care: a UK-based epidemiological study of patient characteristics, comorbidities, and treatments." This project involved Laura Hannah, Laura Angco, Emanuele Osimo, Jonathan Lewis, Cathy Walsh, and Rudolf Cardinal.

Who was involved?

Previous involvement

Contact

Laura Hannah, laura.hannah@cpft.nhs.uk

MH20