Susanne Remvall – Institutionen för kliniska vetenskaper, Lund

Title: Impact of Depression Guideline Implementation on Quality of Care in Child and Adolescent Psychiatry

Main supervisor: Peik Gustafsson, docent, Lunds universitet 

Reviewers: Mia Ramklint, professor, Uppsala universitet and David Mataix-Cols, professor, Karolinska Institutet

Abstract 

Background

Early-onset depression is an increasing concern, significantly contributing to long-term disability and suicide. Despite existing evidence-based interventions, research indicates that child and adolescent psychiatry practices remain largely inadequate. Clinical guidelines aim to improve healthcare quality, but their implementation is complex and often requires multifaceted strategies. Understanding of healthcare processes in this area is limited, with no consensus on conceptualising or measuring quality. This thesis aims to evaluate the effects of tailored guideline implementation on depression healthcare quality in Swedish outpatient child and adolescent psychiatry. It also aims to examine factors associated with healthcare quality and to validate the measurement method.

Research questions

• How can depression healthcare quality be validly and reliably measured?
• To what extent does depression healthcare adhere to guideline standards?
• Are clinical or demographic characteristics related to healthcare quality?
• Is post-intervention quality explained by implementation-related factors?

Preliminary results

A pre-intervention cross-sectional review of medical records (n=284) from Swedish outpatient child and adolescent psychiatry services (n=10) analysed depression assessment documentation using guideline-based quality indicators. Indicator occurrences ranged from 8% to 84%, averaging 49%. Documentation of risk aspects (57%) varied considerably.

Objectifiable characteristics (63%) were recorded more frequently than subjectively experienced symptoms (35%). Comorbidities (13–22%) were rarely documented, whereas functioning and life situation (69%) were well recorded. Predictors, including patient age and sex, self-rating usage, profession, and service site, explained up to 28% of variance, with unidentified service-related factors accounting for 10%. Better documentation was weakly correlated with earlier diagnoses.

Significance

Research on evidence-based care must encompass implementation, as appropriate processes are prerequisites for safe, effective, efficient, patient-centred, equitable, and timely healthcare. This thesis will contribute to understanding psychiatric healthcare quality, the effects of implementation, and associated factors. Effective implementation could conserve resources and improve healthcare quality, thereby reducing suffering and preventing serious consequences such as suicide. This would contribute to substantial societal benefits.

Submitted manuscript

Remvall, S., Santesson, A. H. E., Bäckström, M., Hofvander, B., & Jarbin, H. (2024). Quality of Depression Assessments in Child and Adolescent Psychiatry: Findings from a Nationwide Swedish Outpatient Medical Record Review. Clinical Child Psycholog