ArticleFrontiers in psychiatry2025
Guideline adherence in depression outcome measurement: a retrospective cohort study from Swedish psychiatric outpatient care.
Article in Frontiers in psychiatry, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Routine outcome measurement is a core element of measurement-based care (MBC), yet its use in everyday psychiatric practice remains limited. Even minimal follow-up assessment is often missing despite explicit clinical guideline recommendations. Methods: We conducted a retrospective cohort study of 2431 adult outpatient episodes of depression treatment within Stockholm's public mental health system (2020-2023). Guideline-concordant outcome measurement was defined as documentation of at least one Patient Health Questionnaire-9 (PHQ-9) or clinician-rated Montgomery-Åsberg Depression Rating Scale (MADRS) within 60 days of treatment initiation for all modalities, or within ten sessions for psychotherapy. Adherence rates were compared across antidepressant pharmacotherapy, face-to-face psychotherapy, and internet-based cognitive behavioral therapy (iCBT). Results: Among treatment episodes lasting ≥ 30 days (n = 2242), 28.2% included a PHQ-9 or MADRS within 60 days. Adherence was higher in psychological treatments (71.6%) than in pharmacotherapy (10.2%), χ²(1, N = 2242) = 865.14, Conclusion: Even under conservative criteria, minimal outcome measurement was documented in fewer than one-third of depression treatment episodes. Adherence was particularly low in pharmacotherapy and traditional psychotherapy but substantially higher in iCBT, reflecting the advantages of automated, integrated digital workflows. These findings underscore that policy guidelines alone are insufficient; scalable implementation of MBC requires integrated digital systems, structured workflows, and targeted clinician support.
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