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2015 HSR&D/QUERI National Conference Abstract

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3140 — Evidence Mapping - Do Systematic Reviews Report the Inclusion of Women and Sex as a Moderator of Intervention Effects?

Williams JW, Durham VAMC, Duke University; Duan-Porter W, Durham VAMC, Duke University; Goldstein KM, Durham VAMC, Duke University; LaPointe NA, Duke University Medical Center; Hughes JM, University of North Carolina; Klap RS, Greater LA VAMC; McDuffie JR, Durham VAMC; Clowse ME, Duke University; Gierisch JM, Durham VAMC, Duke University;

Objectives:
Improving healthcare for women veterans is a priority for VHA. We partnered with the Women's Health Services to evaluate the representation of women in studies included in systematic reviews (SR) and whether differential treatment effects for women and men were evaluated.

Methods:
We employed a formal topic prioritization process to identify eligible interventions and conditions. We searched PubMED and the Cochrane library for English-language SR published since 2009, that addressed a medication, behavioral, quality improvement, or exercise intervention for depressive disorders, diabetes mellitus, fibromyalgia, chronic low back pain and chronic knee pain. Data on the inclusion of women, intervention effects and sex effects as a moderator were summarized using descriptive statistics. Results are reported for depressive disorders; evaluation of 1403 citations for other conditions is in progress.

Results:
For depressive disorders, 629 citations were screened and 79 SR were eligible. The most commonly evaluated conditions were: major depressive disorder (n = 54 studies), minor depression (n = 22), dysthymia (n = 21), and treatment-resistant depression (n = 5). Evaluated interventions included: psychotherapy (n = 47), antidepressant medications (n = 34), relapse prevention strategies (n = 6), guided self-help (n = 4), exercise (n = 1) and quality improvement (QI, n = 1). The proportion of women enrolled in the primary studies was reported in 27 SR (34%) and within this subset, women constituted ? 50% of the sample in all pooled estimates. Sex specific effects were evaluated in only 14 SR (18%), using meta-regression (n = 7), patient level meta-analyses (n = 3), subgroup analyses (n = 2), or qualitative synthesis (n = 2). Four SR reported no sex effects for these interventions: therapy vs. antidepressant [AD], therapy and AD vs. AD alone, self-help, and QI. Cognitive behavioral therapy and antidepressants (i.e., SSRI and venlafaxine) were found to be more effective for women than men. Sexual adverse effects were more common in men than women treated with paroxetine.

Implications:
The minority of SR described the inclusion of women or evaluated sex as a moderator of treatment effect. Some depression interventions appear more effective for women.

Impacts:
SR should describe the inclusion of women to facilitate application of findings. SR can help policy makers identify interventions that are particularly effective for women.