Major Depressive Disorder (MDD)

Background

MDD is a serious public health problem in the Department of Defense (DoD), the Veteran Health Administration (VHA) health care systems and in the nation at large; hence, timely diagnosis and effective treatment is an important responsibility of health care providers. About ten to fifteen percent of all primary care patients have MDD, easily making it perhaps the most common disorder that primary care providers see in their practices (Simon, 1999). Research now shows that a range of cost-effective treatments is feasible and efficacious in both the primary care and specialty mental health care settings (Davidson, 1999). Effective treatment can reduce and/or eliminate depression symptoms (Mulrow, 1998), improve health-related quality of life, (Heiligenstein, 1995), and, in some research, even improve occupational performance and productivity among those with MDD (Mintz, 1992). Other research has shown that guideline-driven improvements in the quality of depression care can result in improved symptoms and symptom-related quality of life for those affected (Katon, 1995).

The Veterans Administration (VA) and the Department of Defense (DoD) have developed a clinical practice guideline designed to assist clinicians evaluate and manage adult patients with depression VA/DoD Clinical Practice Guideline for Management of Major Depressive Disorder in Adults, May 00. The Guideline consists of three modules addressing Management of MDD in the primary care setting (Module A), outpatient mental health settings (Module B), and inpatient mental health settings (Module C).

The MDD CPG is one of the supporting guidelines for the DoD/VA Clinical Practice Guideline for Post-Deployment Health Evaluation and Management (PDH-CPG), Dec 01, which was developed to assist primary care providers in evaluating and providing care for individuals with potentially deployment-related health concerns and conditions.

Table of Contents

• Clinical Guidance
• Implementation Guidelines
• Implementation Tools
  • VA/DoD MDD CPG Tool Kit
  • PDH-CPG Desk Reference Toolbox
  • Forms and Asssessment Tools
  • Brochures and Fact Sheets
  • Web-Based Tools
• Other Related Information
• Education and Training
• Research
• Related Links

Clinical Guidance

• VA/DoD Clinical Practice Guideline for Management of Major Depressive Disorder in Adults, May 00
  • Overview of MDD CPG
  • Interactive Guideline
• Institute for Clinical Systems Improvement (ICSI). Major depression in adults in primary care, May 08
• Michigan Quality Improvement Consortium. Management of adults with major depression. May 08
• The Permanente Journal VOL 11 NO 3 Summer 07, Diagnosis and Treatment of Major Depression 2007
• DoD/VA Clinical Practice Guideline for Post-Deployment Health Evaluation and Management, Dec 01
• National Collaborating Centre for Mental Health. Depression: Management of Depression in Primary and Secondary Care. London (UK): National Institute for Clinical Excellence (NICE), 2004
• American Psychiatric Association Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 2000 reviewed Feb 05
  • Psychiatryonline Web Pagewith APA MDD Practice Guideline, clinical tools and related links
• Kaiser Permanente Care Management Institute Depression Clinical Practice Guidelines, Mar 06
• Screening for Depression in Primary Care: Recommendation Statement from the Canadian Task Force on Preventive Health Care, Jan 05
• DHCC Specialized Care Program

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Implementation Guidelines

• Implementation of the VA/DoD Clinical Practice Guideline for the Management of Depressive Disorder in Adults, MEDCOM PowerPoint Presentation
• VA/DoD Manual for Facility Clinical Practice Guideline Champions, Oct 2007
• Rand Manual, Putting Practice Guidelines to Work in the Department of Defense Medical System, 2001
• Management of Depression Action Plan Worksheets
• VA/DoD Performance Measures for the Management of MDD in Adults

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Implementation Tools

• VA/DoD MDD CPG Tool Kit
  • Provider Care Cards
  • Depression Assessment and Referral Provider Care Card, Apr 02
  
  
  
  • Depression Treatment Considerations Provider Care Card, Apr 02
  
  
  
  • Form 717-R Assessment and Treatment Documentation Key Elements and System Level Performance Metrics Provider Care Cards, Apr 02
  
  
  
  • DSM-IV Common Mood Disorders (not inclusive) Provider Care Card, Apr 02
  
  
  
  • DSM IV Multiaxial Assessment Provider Care Card, Apr 02
  
  
  
  • Antidepressant Medication Table Provider Care Card, Apr 02
  
  
  
  • Pocket Guides
  • Primary Care Pocket Guide, Nov 01
  
  
  
  • Outpatient Mental Health Specialty Setting Pocket Guide, Nov 01
  
  
  
  • Inpatient Care Pocket Guide, Nov 01
  
  
  
  • Guideline Summaries
  • Primary Care Guideline Summary, Nov 01
  
  
  
  • Outpatient Mental Health Specialty Setting Guideline Summary, Nov 01
  
  
  
  • Inpatient Care Guideline Summary, Nov 01
  
  
  
  • Key Points
  • Primary Care Key Points, Nov 01
  
  
  
  • Outpatient Mental Health Specialty Setting Key Points, Nov 01
  
  
  
  • Inpatient Care Key Points, Nov 01
  
  
  
  • Posters
  • U.S. Army MEDCOM Quality Management Office Major Depressive Disorder CPG Page under Patient Information
  
  
  
  • Tool Kit Supply and Ordering Information
  • U.S. Army MEDCOM Quality Management Office Web Site Shopping Cart
  
  
  
  • Coding Guidelines
  • Air Force Medical Service Mental Health Coding Handbook, Apr 08
  
  
  
• PDH-CPG Desk Reference Toolbox
  • Major Depressive Disorder Provider ReferencePocket Card, Dec 03
    
    
• Forms and Assessment Tools
  • Army, Depression Outpatient Forms
  • Standard Health Assessment Tools
  
  
  
• Brochures and Fact Sheets
• VA/DoD Brochures
• What You and Your Family Should Know About Depression



• Depression Self-Management, A Guide for Patients



• USUHS, What Military Families Should Know About Depression



• Web-Based Tools
• NetDCMS (A free web-based clinical information system designed to help care managers deliver chronic care services to patients with depression).

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Other Related Information

• TRICARE Behavioral Health Care Services Chart from TriWest
• Depressed? TRICARE Prime Can Help, TRICARE Health Matters Bulletin Issue 4: 2006
• U.S. Preventive Services Task Force (USPSTF) Recommendations and Rationale, Screening for Depression, May 02
• Depression Section, USAF Leader's Guide for Managing Personnel in Distress

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Education and Training

• Deployment Health Clinical Training Series Module, Managing Depression in Primary Care Using the VA/DoD Major Depressive Disorder Clinical Practice Guideline, 7 May 07
• Podcast on DepressionIsReal.org Web site entitled "Depression and Military Service, 17 May 07"  (Discusses mental health programs for returning veterans and their families)
• National Quality Management Program (NQMP) On-Line Education Depression Detection and Management in the Direct Care System (DCS) 2004, 30 Nov 05 (An overview of depression and the findings of the 2004 NQMP Depression Detection and Management quality study.)
• Review of the VHA/DoD Clinical Practice Guideline for the Management of Major Depressive Disorder in Adults, PowerPoint Presentation
• VA/DoD Satellite Broadcast - VA/DoD CPG for the Management of Major Depressive Disorders in Adults", 4 Sep 02 (2 hours) (Can be ordered from US Army MEDCOM Quality Management Office Web site Shopping Cart, Depression Toolkit Item Number DE-001--07-07)
• Institute for Healthcare Improvement, Depression Training Manual, 2002

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Research

• Agency for Healthcare Research and Quality (AHRQ) Study, Comparative Effectiveness of Second- Generation Antidepressants in the Pharmacologic Treatment of Adult Depression, Jan 07
• National Quality Management Program (NQMP), Depression Detection in the Direct Care System Special Study Fact Sheet, 2004
• National Quality Management Program (NQMP), Acute Phase Management of Newly Diagnosed Depression in the Military Health System Special Study Fact Sheet, 2004
• National Quality Management Program (NQMP), Depression Comorbidity in the Military Health System Special Study Fact Sheet, 2004
• National Quality Management Program (NQMP), Depressive Disorder Treatment in the Military Health System (MHS) Special Study Fact Sheet, Revised May 03

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Related Links

• National Institute of Mental Health Depression Page
• MedlinePlus: Depression Page
• The MacArthur Foundation's Initiative on Depression and Primary Care
• Rand Partners in Care: An Integrated Approach to Improving Care for Depression in Primary Care
• American Psychological Association Depression Page
• National Alliance on Mental Illness Major Depression Page
• National Mental Health Association
• Depression and Bipolar Support Alliance
• Depression Is Real Coalition
• afterdeployment (The Military Health System's mental wellness resource Web portal for service members, veterans, and military families suffering post-deployment mental health problems.)
• Defense Centers of Excellence For Psychological Health & Traumatic Brain Injury Web Page
• U.S. Army MEDCOM Quality Management Office
• Veterans Health Administration Office of Quality and Performance, Clinical Practice Guidelines
• VA War Related Illness and Injury Study Centers (WRIISC)
• DoD Mental Health Self-Assessment Program
• TriWest Behavioral Health Portal
• DHCC Suicide Prevention Page