Adult Depression module

Adult Depression module


The bestpractice Decision Support Adult Depression module provides up to date screening, assessment and management tools for health professionals to identify and treat depression in Primary Care. When the module is selected, the Adult Depression guide will be automatically invoked if the patient is 18 years or over. For those under 18 years of age, clinicans are offered assessment tools and resources developed and endorsed for adolescents.


Mental disorders such as depression are common in primary care and are a major cause of disability in New Zealand. The identification and management of mental disorders has been shown to be dependent on a number of factors including the availability of treatment resources and time constraints. However practitioners rarely address mental disorders in isolation from other health problems and tools that facilitate ongoing objective assessment allow practitioners to monitor progress amidst these competing needs.

The bestpractice Decision Support Depression module focuses on best practice guidelines developed for the New Zealand context. These guidelines provide evidence-based practice for most people in most circumstances. They form a basis for decision-making by the health care practitioner, in discussion with the person, in developing an individualised care plan.

How it works

The BPAC Inc web-based Decision Support system offers targeted screening questions for common mental disorders which can be used in high risk patients. If a person responds positively to a screening question, and identifies they want help to address the issue, the module directs users to the appropriate assessment tool.

Direct access to assessment tools
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The option to directly access an appropriate assessment tool appears when the answers to screening questions indicate problem areas should be explore further.

A structured approach to assessment ensures all relevant areas are addressed and enables practitioners to identify risks and protective factors. Although a large number of assessment tools have been validated, it is recommended that practitioners become familiar with a limited repertoire. The self-report measures available through bestpractice Decision Support include PHQ-9 and Kessler-10 for depression, GAD-7 for anxiety and AUDIT and CHAT for alcohol and drug problems.

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The PHQ-9 has been validated for use in primary care and once the patient has answered all the questions, a provisional diagnosis of the severity of any depression is offered by bestpractice Decision Support.

Once the answers to the self-reported questions are completed, bestpractice Decision Support calculates and displays a provisional assessment of the severity of a person's depression. This is automatically saved in a standardised way to the patient's medical record along with any relevant clinical notes.

Assessing suicide risk is challenging for practitioners as there are no markers to predict the presence or intensity of risk and assessment only provides a snapshot at a given time. Consequently monitoring of risk needs to be ongoing as new triggers can occur even if a person's mental state is improving. Questions to assist in assessing this risk are offered to help practitioners distinguish passive from active suicidal ideation. Clinical notes can also be seamlessly recorded during the consultation allowing the vital communication and observational skills of the practitioner to form part of the record. This information is written back to the Patient's Medical Record and included in any referrals.

Assessment of suicide risk
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Assessment of Suicide Risk requires the practitioner to note if there is a definite plan, access to and how lethal these means are, and the presence or lack of risk or protective factors.

The module then makes recommendations based on the New Zealand Guidelines for the Identification of Common Mental Disorders and Management of Depression in Primary Care 2009. The rationale for each management option is also directly available if required. The interventions for depression in adults comprise a spectrum of therapies from exercise and self-management to psychological therapy and/or antidepressants. The bestpractice Decision Support module facilitates these actions as well as providing patient resources such as pamphlets to print and a list of valuable web-based resources to aid self-management.

Sometimes problems take several sessions to 'unravel' in the clinical setting and it is therefore vital to have records easily available for the future and to negotiate active follow-up. The Adult Depression module enables on-going monitoring and adjustment to the intensity of intervention according to patient response: a 'stepped care' approach.

External links

  • New Zealand Guidelines Group. Identification of common mental disorders and management of depression in primary care. An evidences-based Best Practice Guideline. Published by New Zealand Guidelines Group; Wellington: 2008.