Quality Statement 1: Comprehensive Assessment - Health Quality Ontario (HQO)

Resources Quality Statements Advisory Committee About

1

Comprehensive Assessment

People suspected to have major depression have timely access to a comprehensive assessment.

Background

A comprehensive assessment allows for an accurate diagnosis of major depression and the collection of baseline measurements. It also allows for the identification of potential underlying conditions or issues (e.g., physical, cognitive, psychiatric, functional, or psychosocial factors) that may cause symptoms, and it informs their subsequent treatment. In addition, the assessment enables early identification of suicide risk.

What This Quality Statement Means

For Patients

You should receive a comprehensive assessment. An assessment means that your care team will want to learn more about you to understand how best to help you. It should include questions about your physical health, your medical history, what medications you’re taking, how you spend your time, and how you’re feeling.

For Clinicians

If you suspect a person has depression, complete and document a full assessment as described in the Definitions section of this statement.

For Health Services

Ensure systems, processes, and resources are in place to assist clinicians with the assessment of people with suspected depression. This includes ensuring access to laboratory testing and areas for physical examination, providing the time required for a full assessment, and ensuring access to validated assessment tools and to trained professionals competent in suicide risk assessment.

Quality Indicators

Process Indicator

Percentage of people with suspected severe major depression, identified by a health care provider, who receive a comprehensive assessment within 7 days of initial contact

Denominator: total number of people with suspected severe major depression, identified by a health care provider
Numerator: number of people in the denominator who receive a comprehensive assessment within 7 days of initial contact
Data source: local data collection

Percentage of people with suspected mild to moderate major depression, identified by a health care professional, who receive a comprehensive assessment within 4 weeks of initial contact

Denominator: total number of people with suspected mild to moderate major depression identified by a health care professional
Numerator: number of people in the denominator who receive a comprehensive assessment within 4 weeks of initial contact
Data source: local data collection

Definitions Used Within This Quality Statement

Timely access

For suspected severe depression: within 7 days of contact
For suspected mild to moderate depression: within 4 weeks of contact

Comprehensive assessment

This includes the following:

Physical examination
Mental status examination
Relevant laboratory tests
Psychosocial history (including socioeconomic factors and trauma)
In elderly people, cognitive assessment
Diagnosis of major depression using the criteria from DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition)
Use of validated tools for assessing the severity of symptoms and degree of functional impairment, such as:
- Patient Health Questionnaire (PHQ-9)
- Quick Inventory of Depressive Symptomatology—Self-Rated (QIDS-SR)
- Beck Depression Inventory (BDI-I or BDI-II)
- Zung Self-Rating Depression Scale
- Center for Epidemiologic Studies Depression Scale (CES-D)
Assessment of potential medical and psychiatric comorbidities (especially bipolarity and psychosis)
Past treatment history and complete medication history, including self-medication
Current and past substance use and addiction issues
Assessment of suicide risk by a trained professional using suicide risk assessment scales

Note: Suicide risk assessment of young adults and adolescents should involve the parents or caregivers.

The assessment should be culturally sensitive—respectful of diverse cultural, ethnic, and spiritual backgrounds.

Information from the family and relevant third parties should be obtained when appropriate.

Evidence to Improve Care