Barriers and facilitators to implementing deep brain stimulation for psychiatric disorders: a systematic review

Area of Science:

• Neuroscience and Psychiatry
• Neurosurgery
• Mental Health Treatment

Background:

• Deep brain stimulation (DBS) is a proven treatment for severe obsessive-compulsive disorder (OCD) and treatment-resistant depression (TRD).
• Referral rates for DBS in psychiatric disorders are lower than expected, indicating implementation challenges.
• Identifying barriers and facilitators is crucial for improving DBS accessibility and effectiveness in psychiatric care.

Purpose of the Study:

• To systematically review and identify key barriers and facilitators influencing the implementation of DBS for OCD and TRD.
• To provide insights for policymakers and clinicians to enhance DBS accessibility for psychiatric conditions.

Main Methods:

• A systematic review of quantitative and qualitative studies was conducted.
• Four electronic databases were searched until May 1st, 2024.
• Studies describing facilitators or barriers for psychiatric DBS implementation were included, adhering to PRISMA and ENTREQ guidelines.

Main Results:

• Twenty-eight studies were included, focusing on TRD (11), OCD (5), or both (12).
• Identified barriers encompass ethical concerns, safety issues, stigma, and knowledge deficits.
• Facilitators include educational programs, specialized psychiatric DBS services, and stakeholder engagement.

Conclusions:

• This review highlights the need for consensus on treatment resistance and refined referral guidelines for DBS in OCD and TRD.
• Addressing clinician knowledge gaps, particularly among psychiatrists unfamiliar with psychiatric neurosurgery, is essential.
• Improving the public perception of DBS is vital to reduce stigma and enhance its implementation.