Health Quality Ontario’s Major Depression Quality Standard provides guidance for the care of adults and adolescents (13 years of age or older) with depression in all care settings.
The quality standard includes 12 quality statements addressing areas that have high potential for improving the quality of care in Ontario for people with depression.
Below is a sample of tools and resources that may help you with the implementation of the quality statements into practice. Please also see the Major Depression Quality Standard for more tools and information.
Are there other tools or resources you use? Do you have experience implementing these tools? If you have any feedback about any of these tools, please use the comments section below to share!
Tools and Resources for Each Quality Statement
Quality Statement 1. Comprehensive Assessment: People suspected to have major depression have timely access to a comprehensive assessment.
The quality standard lists 11 elements that should be included in a comprehensive assessment for patients with major depression. Please see the Major Depression Quality Standard for more information.
- Patient Health Questionnaire (PHQ-9)—a multipurpose instrument for screening, diagnosing, monitoring, and measuring the severity of depression (validated in multiple languages)
- Center for Epidemiologic Studies Depression Scale Revised (CESD-R)—a screening test for depression and depressive disorder, measuring symptoms defined by the American Psychiatric Association Diagnostic and Statistical Manual (DSM-5) for a major depressive episode
- Opioid Use Disorder Tool—a tool created by the Centre for Effective Practice to support providers in the screening and diagnosis of opioid use, and also provides communication tips to guide discussions with patients
Quality Statement 2. Suicide Risk Assessment and Intervention: People with major depression who are at considerable risk to themselves or others, or who show psychotic symptoms, receive immediate access to suicide risk assessment and preventive intervention.
Many factors should be considered when evaluating the suitability of suicide risk assessment tools, such as the psychometric properties of the tools as well as other technical issues describing their utility. Please see the Major Depression Quality Standard for more information.
Quality Statement 3. Shared Decision-Making: People with major depression jointly decide with clinicians on the most appropriate treatment for them, based on their values, preferences, and goals for recovery. They have access to a decision aid in a language they understand that provides information on the expected treatment effects, side effects, risks, costs, and anticipated waiting times for treatment options.
- Patient Decision Aids—tools developed by The Ottawa Hospital to help patients become more involved in their mental health management
- CHOICE-D Patient and Family Guide to Depression Treatment—a guide to help patients and family members understand the evidence-based treatments that are available for managing depression (based on the CANMAT 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder)
Quality Statement 4. Treatment After Initial Diagnosis: People with major depression have timely access to either antidepressant medication or evidence-based psychotherapy, based on their preference. People with severe or persistent depression are offered a combination of both treatments.
- The Centre for Addiction and Mental Health provides information in plain language on:
- Section 3. Pharmacological Treatments (CANMAT Guidelines)—this section of the Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder provides information on pharmacological treatments for major depression
- BounceBack: Reclaim Your Health—a free, skill-building program designed to help adults and youth 15 years and older manage symptoms of depression and anxiety
Quality Statement 5. Adjunct Therapies and Self-Management: People with major depression are advised about adjunctive therapies and self-management strategies that can complement antidepressant medication or psychotherapy.
- Alternative Treatments—resources developed by the Mobilizing Minds Research Group (a project funded by the Canadian Institutes of Health Research and the Mental Health Commission of Canada) to help patients understand the use of alternative treatments for depression
- CHOICE-D Patient and Family Guide to Depression Treatment—a guide to help patients and family members understand the evidence-based treatments that are available for managing depression (based on theCANMAT 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder)
Quality Statement 6. Monitoring for Treatment Adherence and Response: People with major depression are monitored for the onset of, or an increase in, suicidal thinking following initiation of any treatment. People with major depression have a follow-up appointment with their health care provider at least every 2 weeks for at least 6 weeks or until treatment adherence and response have been achieved. After this, they have a follow-up appointment at least every 4 weeks until they enter remission.
Reassessments can be conducted using the following tools (described in statement 2):
Quality Statement 7. Optimizing, Switching, or Adding Therapies: People with major depression who are prescribed antidepressant medication are monitored for 2 weeks for the onset of effects; after this time, dosage adjustment or switching medications may be considered. People with major depression who do not respond to their antidepressant medication after 8 weeks are offered a different or additional antidepressant, psychotherapy, or a combination of antidepressants and psychotherapy.
- The Centre for Addiction and Mental Health provides information in plain language on:
- Section 3. Pharmacological Treatments (CANMAT Guidelines)—this section of the Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder provides information on pharmacological treatments for major depression
- CHOICE-D Patient and Family Guide to Depression Treatment—a guide to help patients and family members understand the evidence-based treatments that are available for managing depression (based on the CANMAT 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder)
Quality Statement 8. Continuation of Antidepressant Medication: People taking antidepressant medication who enter into remission from their first episode of major depression are advised to continue their medication for at least 6 months after remission. People with recurrent episodes of major depression who are taking antidepressant medication and enter into remission are advised to continue their medication for at least 2 years after remission.
The tools and resources from statements 6 and 7 could continue to be used to monitor symptoms and support patient understanding of their treatment.
Quality Statement 9. Electroconvulsive Therapy: People with severe or treatment-resistant major depression have access to electroconvulsive therapy.
Quality Statement 10. Assessment and Treatment for Recurrent Episodes: People with major depression who have reached full remission but are experiencing symptoms of relapse have timely access to reassessment and treatment.
All of the tools identified in previous statements could be used to assess and treat recurrent episodes of major depression.
Quality Statement 11. Education and Support: People with major depression and their families and caregivers are offered education on major depression and information regarding community supports and crisis services.
- Understanding and Finding Help for Depression (web page)—a plain language overview of depression from the Canadian Mental Health Association
- ConnexOntario—a 24-hour service funded by the Government of Ontario that provides free and confidential support for people experiencing problems with alcohol and drugs, mental illness and/or gambling
- Patient Reference Guide—a resource written in plain language for patients, families, and caregivers to better understand and manage the condition (based on Health Quality Ontario’s Major Depression Quality Standard)
- CHOICE-D Patient and Family Guide to DepressionTreatment—a guide to help patients and
family members understand
the evidence-based treatments that are available for managing depression (based
on the
CANMAT 2016 Clinical Guidelines for the
Management of Adults with Major Depressive Disorder)
Quality Statement 12. Transitions in Care: People with major depression who transition from one care provider to another have a documented care plan that is made available to them and their receiving provider within 7 days of the transition, with a specific timeline for follow-up. People with major depression who are discharged from acute care have a scheduled follow-up appointment with a health care provider within 7 days.
Comprehensive Tools and Resources
The resources below may apply to more than one quality statement in this quality standard.
This quality standard was based largely on the CANMAT Guidelines and CHOICE-D Guide listed below.
Other Tools and Resources
The following tools and/or resources help provide context and background for this quality standard topic.
Comment below to describe your experience with these tools or share any others you have found useful!