Quality of depression assessments in child and adolescent psychiatry: Findings from a nationwide Swedish outpatient medical record review

Abstract

Background: Early-onset depression is an increasing concern, contributing to long-term disability and suicide. Diagnostic assessments are essential for effective treatment. However, research suggests that Child and Adolescent Psychiatry practices remain inadequate. Knowledge of healthcare processes is limited, with no consensus on conceptualising or measuring quality. This study aimed to investigate depression assessments in Swedish outpatient Child and Adolescent Psychiatry, including associations with predictors and diagnostic timeliness. Methods: Medical records (n = 284) from patients aged 8–17 with depression were collected from 10 services. Quality indicators for depressive symptoms, suicidality, comorbidities, and functioning were developed from guidelines. Indicator occurrences were assessed, summarised into components, and analysed using regression and correlations. Results: Indicator occurrences ranged from 8% to 84%, averaging 49%. Documentation varied considerably for risk aspects (57%). Distinct depressive characteristics (63%) occurred nearly twice as often as subtler symptoms (35%). Comorbidities (13%–22%) were rarely documented, whereas functioning and life situation (69%) were well-recorded. Predictors explained up to 28% of variance, with unidentified service-related factors explaining 10%. Better documentation weakly correlated with earlier diagnoses. Conclusions: Findings indicate the need for guideline implementation and further investigation into assessment inequities. Improving quality might promote earlier diagnoses. The indicators may be applicable in similar settings.

Plain Language Summary

How is Depression Assessed in Young People in Sweden? Insights from Medical Records Why this study was done: Depression in young people is becoming more common and is a major cause of long-term health problems and suicide among young people. Accurate assessments are essential for effective treatment, but research shows that current practices often fall short of best standards. There is limited knowledge on how to improve these assessments, and no agreement on how to measure their quality. What was done: This study investigated the quality of depression assessments in Swedish outpatient psychiatry for children and adolescents. Researchers reviewed medical records of 284 patients aged 8–17 diagnosed with depression. The study evaluated how well clinics documented symptoms of depression, suicidality, other mental health issues, and patient functioning, using quality measures based on clinical guidelines. Documentation quality was analysed in relation to patient and clinical characteristics, but also how quickly diagnoses were made. What was found: Documentation quality varied widely, especially for risk assessments. On average, only half of the recommended areas were properly documented. Depressed mood, suicidal thoughts, and sleep disturbance, as well as patient functioning, were the best-documented areas. However, less obvious depressive symptoms, like loss of interest or pleasure (anhedonia), and evaluations of other mental health conditions were often overlooked. Use of self-report tools was linked to better documentation, but unknown clinic-related factors also influenced the recordings. What this means: These findings highlight the need for improved adherence to clinical guidelines and additional training for healthcare providers. Enhancing how depression assessments are documented could lead to more effective evaluations and earlier diagnoses, thereby improving treatment outcomes. The quality measures developed in this study may also be useful for clinics elsewhere to enhance their assessment practices.