Identifying and developing a Community Pharmacy Depression Service in the UK: a systematic review and multi-stakeholder eDelphi study

Introduction: Depression is the most prevalent mental health condition with rates increasing internationally. Community pharmacy personnel are willing to support individuals with mental ill health
Aims/Objectives: To synthesise the international evidence and derive multi-stakeholder consensus on priorities for a community pharmacy-led depression service.
Methods: Standard systematic review methods were used. Medline, EMBASE, PsycINFO and CINAHL were searched from inception to January 2025. Studies exploring community pharmacy-led depression services were included. The consensus process was undertaken as a two-round eDelphi and used ‘Vignettes’ developed from the review results, that described barriers/facilitators and clinical, humanistic, economic outcomes. Participants (people with lived-experience of depression, carers, healthcare providers, policy-makers, and third-sector representatives) rated each item using a 7-point Likert scale (1-7, very low/very high priority), provided justifications for their ratings, and suggested additional services. Medians (and interquartile ranges (IQR)) were calculated; with consensus defined apriori (median ≥5, ‘Moderate Priority’). Free-text responses were thematically analysed in NVivo. Ethical approval was granted by the University of Strathclyde.
Results: The systematic review included 48 studies from 13 nations (including the US (n=13), Australia (n=8), UK (n=5)) and identified five service types. In total, 59 individuals participated in the eDelphi, who identified four additional services. Consensus was achieved with four services with median scores of 6: Treatment Adherence (IQR 5-6), Education/Advice (IQR 4-6), Signposting/Referral (IQR 4-6), and Suicide Prevention (IQR 4-7). Qualitative analysis supported these services for improving patient experience, resource allocation and service delivery, with one participant stating, “this is exactly the sort of service that pharmacy staff should routinely deliver”. Barriers included stigma and resource constraints.
Discussion/Conclusion: There is substantial, multi-stakeholder support for community pharmacy services to support people with depression. Future research will test a Treatment Adherence service encompassing advice, signposting and referral, and exploration of the inclusion of suicide prevention within pharmacy training.