Care pathways for people with major depressive disorder

Abstract

Background: Despite well-established guidelines for managing major depressive disorder (MDD), 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 current32 practice care, specifically to: 1. Identify current treatment gaps along the care pathway and determine the extent of these gaps in comparison with the stepped-care model. 2. Recommend policies intending to better meet patient needs (i.e., minimise treatment gaps). Methods: After agreement upon a set of relevant treatment gaps, data pertaining to each gap were gathered and synthesised from several sources across six European countries. Subsequently a modified-Delphi approach was undertaken to attain consensus amongst an expert panel on proposed recommendations for minimising treatment gaps. Results: 4 recommendations were made to increase the depression diagnosis 40 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 ~1-8 years after illness onset) and increase rates of treatment; 9 further recommendations aimed to increase rates of treatment (from ~25-50% of patients currently treated), mainly focused on targeting the best treatment to each patient. To improve follow-up after treatment initiation (from ~30-65% followed up within 3 months), 7 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.