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Strawbridge R, McCrone P, Ulrichsen A, Zahn R, Eberhard J, Wasserman D, Brambilla P, Schiena G, Hegerl U, Balazs J, Caldas de Almeida J, Antunes A, Baltzis S, Carli V, Quoidbach V, Boyer P, Young AH. Care pathways for people with major depressive disorder: a European Brain Council Value of Treatment study. Eur Psychiatry 2022; 65:1-21. [PMID: 35703080 PMCID: PMC9280921 DOI: 10.1192/j.eurpsy.2022.28] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Despite well-established guidelines for managing major depressive disorder, its extensive disability burden persists. This Value of Treatment mission from the European Brain Council aimed to elucidate the nature and extent of “gaps” between best-practice and current-practice care, specifically to:Identify current treatment gaps along the care pathway and determine the extent of these gaps in comparison with the stepped-care model and Recommend policies intending to better meet patient needs (i.e., minimize treatment gaps). Methods After agreement upon a set of relevant treatment gaps, data pertaining to each gap were gathered and synthesized from several sources across six European countries. Subsequently, a modified Delphi approach was undertaken to attain consensus among an expert panel on proposed recommendations for minimizing treatment gaps. Results Four recommendations were made to increase the depression diagnosis rate (from ~50% episodes), aiming to both increase the number of patients seeking help, and the likelihood of a practitioner to correctly detect depression. These should reduce time to treatment (from ~1 to ~8 years after illness onset) and increase rates of treatment; nine further recommendations aimed to increase rates of treatment (from ~25 to ~50% of patients currently treated), mainly focused on targeting the best treatment to each patient. To improve follow-up after treatment initiation (from ~30 to ~65% followed up within 3 months), seven recommendations focused on increasing continuity of care. For those not responding, 10 recommendations focused on ensuring access to more specialist care (currently at rates of ~5–25% of patients). Conclusions The treatment gaps in depression care are substantial and concerning, from the proportion of people not entering care pathways to those stagnating in primary care with impairing and persistent illness. A wide range of recommendations can be made to enhance care throughout the pathway.
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Affiliation(s)
- Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Paul McCrone
- Centre for Mental Health, University of Greenwich, London, United Kingdom
| | - Andrea Ulrichsen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Roland Zahn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Jonas Eberhard
- Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giandomenico Schiena
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ulrich Hegerl
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Judit Balazs
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Department of Psychology, Bjørknes University College, Oslo, Norway
| | - Jose Caldas de Almeida
- Chronic Diseases Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Ana Antunes
- Chronic Diseases Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Spyridon Baltzis
- Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Vladmir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
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