The Depression Audit

Criteria	Audit Details	More information
Electronic Version Available for EMIS LV users

Mental Health problems are common and primary care teams provide most of the help that individuals need. The National Service Framework (NSF) for Mental Health, which was produced in 1999, states that at any one time one adult in six suffers from one or other form of mental illness. In other words mental illnesses are as common as asthma.

Within the forward of the NSF there was conformity that despite the prevalence of mental illnesses it hasnt had the attention it deserves, and therefore the NSF was developed to develop national standards for mental health.

Depression is seen as a major contributor within mental illness. The NSF remarks that,

Unemployed people are twice as likely to have depression as people in work
Half of all women and a quarter of all men will be affected by depression at some period during their working lives.
Only about 30% to 50% of depression in primary care is recognised by GPs.
Each year one woman in every 15 and one man in every 30 will be affected by depression.
Most of the 4,000 suicides committed each year in England are attributed to depression.

A multi-disciplinary group have worked with PCAG to devise the Major Depression Audit, which is currently being rolled out within Leicestershire and Rutland. The audit will assess areas including prescribing, referrals, reviewing, and whether patients are assessed for suicide risk. The criteria for the audit are shown below.

Criteria

The records show that the diagnosis of major depression is correct.
The records show that at diagnosis the patient has been assessed for risk of suicide.
The records show that patients with major depression are treated with antidepressants and/or have been assessed and considered for further treatment.
The records show that antidepressants must be prescribed in therapeutic doses.
The records show that after commencement of treatment, the patient should be reviewed every one to three weeks during the first four to six weeks of treatment, and the risk of suicide reassessed.
The records show that drug treatment should be continued for at least 4 months after the episode of depression has resolved.

The evidence behind the above criteria can be obtained by contacting PCAG.

Audit Details

After much discussion it was decided that this audit should be prospective and each GP is being asked to identify 20 new patients or however many new patients they see within a nine month period. The criteria for diagnosing Major Depression is shown in box 1.1

Box 1.1

Patients to be included in the audit will have a diagnosis of major depression. This is defined by the ICD-1 Classification for Major Depression.

2 or 3 symptoms from:

Low or sad mood
Loss of interest or pleasure
Fatigue or loss of energy

Plus 3 or 4 other symptoms:

Disturbed sleep
Guilt or low self worth
Poor concentration
Disturbed appetite
Suicidal thoughts or acts
Anxiety
Retardation or agitation

The level of problem is such as to present great difficulty in continuing with normal activities (e.g. off work) and should be present for at least 2 weeks

Once all the patients have been identified, data will be collected on the applicable patients after a period of time (4 months) has elapsed to allow for interventions, treatment and referral.

Want more information?

PCAG will be happy to answer any queries surrounding the major depression audit, please use the details supplied at the top of the page.

The Depression Audit

Unemployed people are twice as likely to have depression as people in work

Half of all women and a quarter of all men will be affected by depression at some period during their working lives.

Only about 30% to 50% of depression in primary care is recognised by GPs.

Each year one woman in every 15 and one man in every 30 will be affected by depression.

Most of the 4,000 suicides committed each year in England are attributed to depression.

Criteria

The records show that the diagnosis of major depression is correct.

The records show that at diagnosis the patient has been assessed for risk of suicide.

The records show that patients with major depression are treated with antidepressants and/or have been assessed and considered for further treatment.

The records show that antidepressants must be prescribed in therapeutic doses.

The records show that after commencement of treatment, the patient should be reviewed every one to three weeks during the first four to six weeks of treatment, and the risk of suicide reassessed.

The records show that drug treatment should be continued for at least 4 months after the episode of depression has resolved.

Audit Details

Want more information?

Only about 30% to 50% of depression in primary care is recognised by GPs.

The records show that patients with major depression are treated with antidepressants and/or have been assessed and considered for further treatment.