Table 1 Quality indicators for evaluation of quality of care in depression treatment and care after a suicide attempt.

Accessibility/wait time

The time between referral and actual contact with mental health service

Patients receive an assessment from a mental health specialist within three weeks of their first visit to the outpatient clinic. Patients with depression and suicidal thoughts offered first contact (appointment) within 24 hours.

Diagnostic assessment

Documentation of present depression symptoms. The medical record should document at least three of nine DSM-IV target symptoms for major depression.

Depression symptoms (such as decreased socialization, sleep disorders, poor appetite according DSM-IV) noted in the medical record.

Standardized rating scale

Clinical depression assessment that includes a standardized rating scale.

Monitoring signs and symptoms of depression using a validated standardized rating scale at the first visit. Scale and total sum documented in the medical record. Suggestions of scales to be used were presented in the guidelines.

Diagnostic instrument

Diagnostic structured interview

A semi-structured diagnostic interview e.g., SCID or M.I.N.I performed. Completed before the third visit.

Standardized rating scale during treatment

Standardized rating scale during treatment for assessment of symptoms and behaviour.

Standardized rating scale performed within two weeks. Monitoring signs and symptoms of depression using standardized rating scale during treatment. Adjusted interventions if signs and symptoms are still present, presented in the guidelines.

Substance, drug abuse

Screening for substance use disorder.

Asked for current substance use and evaluated for the presence and/or history of substance use disorder. Screenings instruments such as AUDIT. Motivation interview conducted e.g., CAGE method.

Treatment plan (care plan)

A written treatment plan documented and individually tailored for the patient

The treatment plan should include; treatment, goals, time for evaluation and drawn up together with the patient.

Evaluation/Outcome

Has patient responded to antidepressant? Achieved symptom remission or reduction between admission and follow-up?

Documented response to treatment within expected treatment frame and monitored progress. Completed a comprehensive evaluation of symptoms.

Continuity

Ability to provide uninterrupted care over time.

Continuity offered to the patient, same caregiver during treatment. Defined as less than two different caregivers.

Suicide assessment

A structured assessment documented in the medical record using standardized rating scale.

Identified suicidal thoughts, plans and symptoms, documented and evaluated in the medical record. Re-screen and assessment performed at every visit and documented in the medical record.

Antidepressant medication

Current treatment with an antidepressant medication for patients with major depressive disorder, moderate or severe.

Begin appropriate antidepressant medication according the guidelines. Started within two visits.

Specialist assessment after suicide attempt

Assessment by a senior physician within 24 hours after a suicide attempt

A senior mental health specialist has made the assessment within 24 hours.

Suicide assessment

A structured assessment documented in the medical record using standardized rating scales.

Identified suicidal thoughts, plans and symptoms, documented and evaluated in the medical record. Depression assessment conducted using standardized rating scale.

Follow-up

Care plan formulated and documented.

Documented discharge plans. Referral to a psychiatric outpatient clinic

Evaluation

Documented assessment after discharge.

Should have a follow-up visit with a mental health specialist within one week after assessment or discharge. Telephone contact with patient during this period.