Care pathways for people with major depressive disorder

Abstract

Introduction Major depressive disorder (MDD) is a leading cause of disability worldwide, in part due to its high prevalence and high rates of comorbidities, recurrence, chronicity and treatment-resistance. These indicate that MDD is treated suboptimally despite a multitude of effective interventions and well-regarded best-practice treatment guidelines. To improve the management of MDD, the nature and extent of ‘gaps’ in care pathways need to be understood. Objectives We aimed to: 1. Identify ‘treatment gaps’ and patient needs along the care pathway, and determine the extent of these gaps (i.e. discrepancy between best- and current-practice). 2. Propose policy recommendation on how minimise treatment gaps for MDD. Methods Care pathway analysis: A set of relevant treatment gaps were agreed upon, a priori, based on gold-standard stepped-care guidelines. Data was gathered from a variety of sources in six countries (UK, Sweden, Germany, Italy, Portugal, Hungary). Policy recommendations: To attain expert consensus on proposed recommendations, a modified-Delphi approach was undertaken with a multidisciplinary panel of experts across Europe. Results Taken together, data indicated that: ˜50% of episodes are undiagnosed, lifetime delay to treatment averages ˜4 years, ˜25-50% of patients are treated at any one time, ˜30-65% are followed up within 3 months of treatment, ˜5-25% can access psychiatric services. 28 specific recommendations to optimise pathways were made to enhance MDD detection (pathway entry), increase multimodal treatment, facilitate continuity of follow-up after treatment and increase access to specialist care. Conclusions There are concerning treatment gaps in depression care across Europe, from the proportion of people not being diagnosed to those stagnating in primary care with impairing, persistent illness. Disclosure No significant relationships.

Keywords

• major depression
• care pathways
• treatment gaps