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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.

1

Comprehensive Assessment

People suspected to have major depression have timely access to a comprehensive assessment.


A comprehensive assessment allows for an accurate diagnosis of major depression and the collection of baseline measurements. It also allows for the identification of potential underlying conditions or issues (e.g., physical, cognitive, psychiatric, functional, or psychosocial factors) that may cause symptoms, and it informs their subsequent treatment. In addition, the assessment enables early identification of suicide risk.

For Patients

You should receive a comprehensive assessment. An assessment means that your care team will want to learn more about you to understand how best to help you. It should include questions about your physical health, your medical history, what medications you’re taking, how you spend your time, and how you’re feeling.


For Clinicians

If you suspect a person has depression, complete and document a full assessment as described in the Definitions section of this statement.


For Health Services

Ensure systems, processes, and resources are in place to assist clinicians with the assessment of people with suspected depression. This includes ensuring access to laboratory testing and areas for physical examination, providing the time required for a full assessment, and ensuring access to validated assessment tools and to trained professionals competent in suicide risk assessment.

Process Indicator

Percentage of people with suspected severe major depression, identified by a health care provider, who receive a comprehensive assessment within 7 days of initial contact

  • Denominator: total number of people with suspected severe major depression, identified by a health care provider

  • Numerator: number of people in the denominator who receive a comprehensive assessment within 7 days of initial contact

  • Data source: local data collection

Percentage of people with suspected mild to moderate major depression, identified by a health care professional, who receive a comprehensive assessment within 4 weeks of initial contact

  • Denominator: total number of people with suspected mild to moderate major depression identified by a health care professional

  • Numerator: number of people in the denominator who receive a comprehensive assessment within 4 weeks of initial contact

  • Data source: local data collection

Timely access
  • For suspected severe depression: within 7 days of contact

  • For suspected mild to moderate depression: within 4 weeks of contact


Comprehensive assessment

This includes the following:

  • Physical examination

  • Mental status examination

  • Relevant laboratory tests

  • Psychosocial history (including socioeconomic factors and trauma)

  • In elderly people, cognitive assessment

  • Diagnosis of major depression using the criteria from DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition)

  • Use of validated tools for assessing the severity of symptoms and degree of functional impairment, such as:

    • Patient Health Questionnaire (PHQ-9)

    • Quick Inventory of Depressive Symptomatology—Self-Rated (QIDS-SR)

    • Beck Depression Inventory (BDI-I or BDI-II)

    • Zung Self-Rating Depression Scale

    • Center for Epidemiologic Studies Depression Scale (CES-D)

  • Assessment of potential medical and psychiatric comorbidities (especially bipolarity and psychosis)

  • Past treatment history and complete medication history, including self-medication

  • Current and past substance use and addiction issues

  • Assessment of suicide risk by a trained professional using suicide risk assessment scales

    Note: Suicide risk assessment of young adults and adolescents should involve the parents or caregivers.

The assessment should be culturally sensitive—respectful of diverse cultural, ethnic, and spiritual backgrounds.

Information from the family and relevant third parties should be obtained when appropriate.

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