Procedure
The process of developing the standard of care depressive disorders started with the formation of the working group with delegates of all relevant stakeholders: professionals working in primary, general and specialized health care and the patients and family representatives. An advisory board was installed with the relevant stakeholders including representatives of insurance companies. The development process was supported by researchers of the Netherlands Research Institute for Mental Health.
As a first step, the existing clinical guidelines and comparable documents to improve care for depressed patients were studied. The most important one is the Dutch multidisciplinary guideline for depression7 and its addenda for the elderly and the young.
Important elements that were missing or were outdated in this multidisciplinary guideline were notified and selected. The topics were prioritized and a selection was made as not all topics could be addressed for time reasons. This was done by professionals and patients. Persistent depression (including dysthymia) and the effects of food and nutritional supplements in the treatment of depression were prioritized. An update of the guideline was performed for these topics according to the evidence-based guideline development procedure,8.
At the same time a survey was carried out among members of patients association for depression in the Netherlands to assess the needs of patients with regard to relapse prevention of depression. A focus group meeting was organized for patients to address the key issues from the patients perspective in the care for persistent depression.
The development of the standard consisted of several meetings with the working group to discuss the existing clinical guidelines for depression, that were summarized by the researchers. An preliminary text of the standard was presented as a working document. New information from the updates and the survey was discussed in the working group. After consensus was reached, it was integrated in the standard. A concept version of the standard was commented upon by the advisory board and subsequently send to all the participating organizations for comments and finally authorization.