Care pathways for people with major depressive disorder: a European Brain Council Value of Treatment study

Rebecca Strawbridge; Paul Mccrone; Andrea Ulrichsen; Roland Zahn; Jonas Eberhard; Danuta Wasserman; Paolo Brambilla; Giandomenico Schiena; Ulrich Hegerl; Judit Balazs; Jose Caldas De Almeida; Ana Antunes; Spyridon Baltzis; Vladimir Carli; Vinciane Quoidbach; Patrice Boyer; Allan H Young

doi:10.1192/j.eurpsy.2022.28

Care pathways for people with major depressive disorder: a European Brain Council Value of Treatment study

Rebecca Strawbridge, Paul Mccrone, Andrea Ulrichsen, Roland Zahn, Jonas Eberhard, Danuta Wasserman, Paolo Brambilla, Giandomenico Schiena, Ulrich Hegerl, Judit Balazs, Jose Caldas De Almeida, Ana Antunes, Spyridon Baltzis, Vladimir Carli, Vinciane Quoidbach, Patrice Boyer, Allan H Young

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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: 1. Identify current treatment gaps along the care pathway and determine the extent of these gaps in comparison with the stepped-care model and 2. 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 ∼8Â 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 3Af; 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.

Original language	English
Article number	e36
Pages (from-to)	1-21
Journal	European Psychiatry
Volume	65
Issue number	1
Early online date	15 Jun 2022
DOIs	https://doi.org/10.1192/j.eurpsy.2022.28
Publication status	Published - 15 Jun 2022

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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, A. H. (2022). Care pathways for people with major depressive disorder: a European Brain Council Value of Treatment study. European Psychiatry, 65(1), 1-21. Article e36. https://doi.org/10.1192/j.eurpsy.2022.28

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title = "Care pathways for people with major depressive disorder: a European Brain Council Value of Treatment study",

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: 1. Identify current treatment gaps along the care pathway and determine the extent of these gaps in comparison with the stepped-care model and 2. 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{\^A} 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 3Af; 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.",

author = "Rebecca Strawbridge and Paul Mccrone and Andrea Ulrichsen and Roland Zahn and Jonas Eberhard and Danuta Wasserman and Paolo Brambilla and Giandomenico Schiena and Ulrich Hegerl and Judit Balazs and {Caldas De Almeida}, Jose and Ana Antunes and Spyridon Baltzis and Vladimir Carli and Vinciane Quoidbach and Patrice Boyer and Young, {Allan H}",

year = "2022",

month = jun,

day = "15",

doi = "10.1192/j.eurpsy.2022.28",

language = "English",

volume = "65",

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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 2022, 'Care pathways for people with major depressive disorder: a European Brain Council Value of Treatment study', European Psychiatry, vol. 65, no. 1, e36, pp. 1-21. https://doi.org/10.1192/j.eurpsy.2022.28

TY - JOUR

T1 - Care pathways for people with major depressive disorder

T2 - a European Brain Council Value of Treatment study

AU - Strawbridge, Rebecca

AU - Mccrone, Paul

AU - Ulrichsen, Andrea

AU - Zahn, Roland

AU - Eberhard, Jonas

AU - Wasserman, Danuta

AU - Brambilla, Paolo

AU - Schiena, Giandomenico

AU - Hegerl, Ulrich

AU - Balazs, Judit

AU - Caldas De Almeida, Jose

AU - Antunes, Ana

AU - Baltzis, Spyridon

AU - Carli, Vladimir

AU - Quoidbach, Vinciane

AU - Boyer, Patrice

AU - Young, Allan H

PY - 2022/6/15

Y1 - 2022/6/15

N2 - 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: 1. Identify current treatment gaps along the care pathway and determine the extent of these gaps in comparison with the stepped-care model and 2. 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 ∼8Â 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 3Af; 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.

AB - 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: 1. Identify current treatment gaps along the care pathway and determine the extent of these gaps in comparison with the stepped-care model and 2. 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 ∼8Â 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 3Af; 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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DO - 10.1192/j.eurpsy.2022.28

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SN - 0924-9338

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JO - European Psychiatry

JF - European Psychiatry

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Care pathways for people with major depressive disorder: a European Brain Council Value of Treatment study

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