Complementary and alternative medicine mention and recommendations in guidelines for anxiety: A systematic review and quality assessment

•Complementary and alternative medicine (CAM) use is prevalent among patients diagnosed with anxiety.•An assessment of CAM recommendations in anxiety practice guidelines is absent.•CAM recommendations were present in slightly more than half of all eligible guidelines.•Quality of CAM recommendations varied within and across guidelines.•A gap exists as the majority of guidelines do not provide CAM recommendations. Up to 43% of patients with anxiety disorders (ADS) use complementary and alternative medicine (CAM), however, many healthcare providers receive little training on this topic. Clinical practice guidelines (CPGs) are relied upon to guide decision-making, especially with respect to topics less familiar to healthcare providers. In the present study, we identified the quantity and assessed the quality of CAM recommendations in CPGs for the treatment and/or management of ADS. MEDLINE, EMBASE, and CINAHL were systematically searched from 2009 to April 2020 to identify eligible CPGs. In addition, the Guidelines International Network and the National Center for Complementary and Integrative Health websites were also searched. Eligible CPGs containing CAM recommendations were evaluated using AGREE II. Eleven CPGs were eligible, of which six made CAM recommendations. Average scaled domain percentages for these six CPGs from highest to lowest were as follows (% overall, % CAM): clarity and presentation (83.3%, 73.6%); scope and purpose (77.8%, 76.4%); editorial independence (69.4%, 36.8%); stakeholder involvement (55.6%, 31.9%); rigour of development (53.1%, 46.9%); and applicability (43.8%, 29.2%). A need exists to improve the quality of CAM recommendations in anxiety CPGs through insight from AGREE II and other CPG development resources.