Major depressive disorder (MDD) is one of the most burdensome illnesses in Canada. The purpose of this introductory section of the 2009 revised CANMAT guidelines is to provide definitions of the depressive disorders (with an emphasis on MDD), summarize Canadian data concerning their epidemiology and describe overarching principles of managing these conditions. This section on "Classification, Burden and Principles of Management" is one of 5 guideline articles in the 2009 CANMAT guidelines.
The CANMAT guidelines are based on a question-answer format to enhance accessibility to clinicians. An evidence-based format was used with updated systematic reviews of the literature and recommendations were graded according to the Level of Evidence using pre-defined criteria. Lines of Treatment were identified based on criteria that included evidence and expert clinical support.
Epidemiologic data indicate that MDD afflicts 11% of Canadians at some time in their lives, and approximately 4% during any given year. MDD has a detrimental impact on overall health, role functioning and quality of life. Detection of MDD, accurate diagnosis and provision of evidence-based treatment are challenging tasks for both clinicians and for the health systems in which they work.
Epidemiologic and clinical data cannot be seamlessly linked due to heterogeneity of syndromes within the population.
In the eight years since the last CANMAT Guidelines for Treatment of Depressive Disorders were published, progress has been made in understanding the epidemiology and treatment of these disorders. Evidence supporting specific therapeutic interventions is summarized and evaluated in subsequent sections.
"These guidelines review the literature on various treatment interventions and reinforce the importance of psychological therapies in the effective management of depression. Current Canadian guidelines for the treatment of depression recommend a disease management approach as follows: " Disease management for depression typically includes several elements: (1) active efforts to detect depression using screening questions or rating scales, (2) delivery of evidence-based care, including both antidepressant medications and psychotherapy (3), case-management in a collaborative context with 'stepped' care options, (4) patient education about depression and (5) process measurement such as monitoring of the timeliness and quality of care in addition to measurement of symptomatic outcome in patients " (Patten et al. 2009, pp. S10–S11). "
"Here, we advocate along with others (e.g. McKnight and Kashdan, 2009; Patten et al., 2009) that restora tion of functioning should be consid ered a primary goal for treatment, over and above the longstanding "
"It is widely believed that depressive disorder severity should guide treatment selection (such as deciding whether to prescribe chemical antidepressants), and many guidelines emphasise this factor (NHS National Institute for Clinical Excellence, 2009; Anderson et al., 2008; Bauer et al., 2007; New Zealand Guidelines Group, 2008; Patten et al., 2009). The use of rating scales in everyday practice has been proposed in an effort to assist and codify such treatment decisions. "
[Show abstract][Hide abstract] ABSTRACT: It is widely believed that severity of depressive disorder should guide treatment selection and many guidelines emphasise this factor. The Quick Inventory of Depressive Symptomatology (QID-SR) is a self-complete measure of depression severity which includes all DSM-IV criterion symptoms for major depressive disorder. The object of this study was to assess the psychometric properties of the QIDS-SR in a primary care sample. Adult primary care patients completed the QIDS-SR and were assessed by a psychiatrist (blind to QIDS-SR) with the 17-item Hamilton Rating Scale for Depression (GRID-HAMD). Internal consistency, homogeneity and convergent and discriminant validity of the QIDS-SR were assessed. Severity cut-off scores for QIDS-SR were assessed for convergence with HRSD-17 cut-offs. Published methods for converting scores to HRSD-17 were also assessed. Two hundred and eighty-six patients participated: mean age = 49.5 (s.d. = 13.8), 68% female, mean HRSD-17 = 12.6 (s.d. = 7.6). The QIDS-SR exhibited acceptable internal consistency (Cronbach's alpha = 0.86), a robust factor structure indicating one underlying dimension and correlated highly with the HRSD-17 (r = 0.79) but differed significantly in how it categorised the severity of depression relative to the HRSD-17 (Wilcoxon Signed Rank Test p < 0.001). Using published methods to convert QIDS-SR scores to HRSD-17 scores did not result in alignment of severity categorisation. In conclusion, psychometric properties of the QIDS-SR were found to be strong in terms of internal consistency, factor structure and convergent and discriminant validity. Using conventional scoring and conversion methods the scale was found not to concur with the HRSD-17 in categorising the severity of depressive symptoms.
Journal of Psychiatric Research 05/2013; 47(5):592-8. DOI:10.1016/j.jpsychires.2013.01.019 · 3.96 Impact Factor
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