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Evidence to Improve Care

Major of Depression

Care for Adults and Adolescents

Click below to see a list of brief quality statements and scroll down for more information.


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence.

See below for the quality statements and click for more detail.


Quality Statement 1: Comprehensive Assessment
People suspected to have major depression have timely access to a comprehensive assessment.


Quality Statement 2: Suicide Risk Assessment and Intervention
People with major depression who are at considerable risk to themselves or others, or who show psychotic symptoms, receive immediate access to suicide risk assessment and preventive intervention.


Quality Statement 3: Shared Decision-Making
People with major depression jointly decide with clinicians on the most appropriate treatment for them, based on their values, preferences, and goals for recovery. They have access to a decision aid in a language they understand that provides information on the expected treatment effects, side effects, risks, costs, and anticipated waiting times for treatment options.


Quality Statement 4: Treatment After Initial Diagnosis
People with major depression have timely access to either antidepressant medication or evidence-based psychotherapy, based on their preference. People with severe or persistent depression are offered a combination of both treatments.


Quality Statement 5: Adjunct Therapies and Self-Management
People with major depression are advised about adjunctive therapies and self-management strategies that can complement antidepressant medication or psychotherapy


Quality Statement 6: Monitoring for Treatment Adherence and Response
People with major depression are monitored for the onset of, or an increase in, suicidal thinking following initiation of any treatment. People with major depression have a follow-up appointment with their health care provider at least every 2 weeks for at least 6 weeks or until treatment adherence and response have been achieved. After this, they have a follow-up appointment at least every 4 weeks until they enter remission.


Quality Statement 7: Optimizing, Switching, or Adding Therapies
People with major depression who are prescribed antidepressant medication are monitored for 2 weeks for the onset of effects; after this time, dosage adjustment or switching medications may be considered. People with major depression who do not respond to their antidepressant medication after 8 weeks are offered a different or additional antidepressant, psychotherapy, or a combination of antidepressants and psychotherapy.


Quality Statement 8: Continuation of Antidepressant Medication
People taking antidepressant medication who enter into remission from their first episode of major depression are advised to continue their medication for at least 6 months after remission. People with recurrent episodes of major depression who are taking antidepressant medication and enter into remission are advised to continue their medication for at least 2 years after remission.


Quality Statement 9: Electroconvulsive Therapy
People with severe or treatment-resistant major depression have access to electroconvulsive therapy.


Quality Statement 10: Assessment and Treatment for Recurrent Episodes
People with major depression who have reached full remission but are experiencing symptoms of relapse have timely access to reassessment and treatment.


Quality Statement 11: Education and Support
People with major depression and their families and caregivers are offered education on major depression and information regarding community supports and crisis services.


Quality Statement 12: Transitions in Care
People with major depression who transition from one care provider to another have a documented care plan that is made available to them and their receiving provider within 7 days of the transition, with a specific timeline for follow-up. People with major depression who are discharged from acute care have a scheduled follow-up appointment with a health care provider within 7 days.

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Suicide Risk Assessment and Intervention

People with major depression who are at considerable risk to themselves or others, or who show psychotic symptoms, receive immediate access to suicide risk assessment and preventive intervention.


People with major depression have an increased lifetime risk of suicide and should be assessed for suicide risk on initial contact and throughout treatment. Health care providers, family members, and caregivers should be alert for suicide risk in people with a sad or depressed mood, suicidal ideation, and one or more risk factors, including previous suicide attempts, a family history of suicide, physical or sexual abuse, family violence, and chronic pain.

For Patients

You should receive immediate help if you or your health care professional feels you’re at risk of harming yourself or someone else. This help might take place at your health care professional’s office or in an emergency department.


For Clinicians

If you suspect a person with major depression may be at risk to themselves or others, or if they show psychotic symptoms, complete and document a full suicide risk assessment, as described in the Definitions section of this statement. If the person is deemed to be at risk for suicide, provide urgent preventive intervention as described in the Definitions section.


For Health Services

Ensure the availability of suicide risk assessment tools, resources, and trained professionals.

Process Indicator

Percentage of people with major depression identified by a trained professional to be at considerable risk to themselves or others, or who show psychotic symptoms, who receive immediate access to suicide risk assessment and, if necessary, preventive intervention

  • Denominator: total number of people with major depression identified by a trained professional to be at considerable risk to themselves or others or who show psychotic symptoms
  • Numerator: number of people in the denominator who receive immediate access to suicide risk assessment and, if necessary, preventive intervention
  • Data source: local data collection
Immediate access

Help is offered at the point of contact.


Suicidal risk assessment

This includes questions about:

  • Suicidal thoughts, intent, plans, means, and behaviours (hopelessness)
  • Specific psychiatric symptoms (e.g., psychosis, severe anxiety, substance use) or general medical conditions, as well as psychiatric treatment that may increase the likelihood of acting on suicidal ideas
  • Past and, particularly, recent suicidal behaviours
  • Current stressors and potential protective factors (e.g., positive reasons for living, social support)
  • Family history of suicide or mental illness

Suicide risk assessment scales can be used by trained professionals to guide assessment.


Suicide preventive interventions

These include involuntary admission to hospital, observation every 15 minutes or one-to-one constant observation, urgent medication treatment, and urgent electroconvulsive therapy.

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