Interventions Promoting Recovery from Depression for Patients Transitioning from Outpatient Mental Health Services to Primary Care: Protocol for a Scoping Review

Introduction Patients with severe Major Depressive Disorder (MDD) have an increasing risk of new psychiatric hospitalizations following each new episode of depression highlighting the recurrent nature of the disorder. Furthermore, patients are not fully recovered at the end of their treatment in outpatient mental health services, and residual symptoms of depression might explain why patients with MDD have a high risk of relapse. However, evidence of methods to promote recovery after discharge from outpatient mental health services is lacking. The proposed scoping review aims to systematically scope, map and identify the literature and knowledge gaps on existing interventions that promote recovery from MDD for patients transitioning from outpatient mental health services to primary care. Methods and analysis The proposed scoping review will follow the latest methodological guidance by the Joanna Briggs Institute (JBI) in tandem with the Preferred Reporting Items for Systematic reviews and Meta-Analysis - extension for Scoping Reviews (PRISMA-ScR) checklist. The review is ongoing. Four electronic databases (Medline via PubMed, PsycINFO, CINAHL, and Sociological Abstracts) were systematically searched from 20 January 2022 till 29 March 2022 using keywords and text words. The review team consists of three independent screeners. Two screeners have completed the initial title and abstract screening for all studies retrieved by the search strategy. Currently, we are in the full text screening phase. Reference lists of included studies will be screened, and data will be independently extracted by the review team. Results will be analyzed qualitatively and quantitatively. Ethics and dissemination The chosen methodology is based on the use of publicly available information and does not require ethical approval. Results will be published in an international peer reviewed scientific journal and additionally shared with relevant local and national authorities. Registration Following publication, we intend to register the protocol on Open Science Framework. Data availability statement Data sharing not applicable as no datasets generated and/or analyzed for this study. Strengths and limitations of this study To our knowledge, this scoping review is the first to identify and map interventions that aim to promote recovery from severe major depressive disorder for patients transitioning from outpatient mental health services to primary care. The proposed scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis - extension for Scoping Reviews in tandem with the latest framework for scoping review proposed by the Joanna Briggs Institute. The review will not assess the quality of intern validity of included studies. However, we will outline the key characteristics of the best-available evidence in the area and comment of the applicability of the evidence in various settings. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by Helsefonden (21-B-0478), Jaschafonden (2021-0082) and Tvaerspuljen (P-2022-1-08). The funding source supports the investigators salary to carry out this review. Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital is supported by a core grant from the Oak Foundation (OCAY-18-774-OFIL). The funders will not be involved in the study design, collection, analysis, or interpretation of data, writing the manuscript, and the decision to submit the manuscript for publication. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The chosen methodology (protocol for a scoping review) is based on the use of publicly available information and does not require ethical approval. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data sharing not applicable to this article as no datasets were generated or analysed during the current study. * Abbreviation / concept : Definition MDD : Major Depressive Disorder DSM-IV : The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ICD-10 : International Classification of Diseases and Related Health Problems 10th Revision Co-design : A participatory approach to design interventions in collaboration with stakeholders. Stakeholder : Any individual or group who is responsible for or affected by health- and healthcare-related decisions that can be informed by research evidence [[82][1]]. In this study stakeholders are patients, general practitioners, psychiatrists, nurses, job-consultants, medical social workers, and researchers. Patients transitioning : When patients move between care settings. In this study, we focus on patients’ transition from outpatient mental health services to primary care. [1]: #ref-82