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Important elements that were missing or were outdated in this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.