Measurement-based care

What is measurement-based care (MBC)?

Measurement-based care (MBC) describes the process of routinely using outcome measurement to guide treatment decisions. MBC is equivalent to measuring blood pressure when treating hypertension and measuring blood glucose and hemoglobin A1c when treating diabetes. For psychiatry, MBC is accomplished by using validated rating scales to measure outcomes including symptoms, side effects, functioning, and quality of life. MBC for depression consists of using routine outcome assessment in clinical care, timely adjustments of medication and counseling based on outcome assessments, and timely changes in treatments when outcomes are not achieved.

What rating scales are useful for MBC for depression?

We recommend using simple patient-rated scales for efficiency in busy clinical settings. Patient-rated scales are highly correlated with clinician-rated scales but take less time and training to complete. The scales can be completed and scored by the patient in the waiting room or at home before appointments. The scales we recommend are brief, free or inexpensive to use in clinical care, and available in several languages.

    • Quick Inventory of Depressive Symptomatology, Self-Rated (QIDS-SR) for depressive symptoms;
      (alternate) Personal Health Questionnaire (PHQ-9)
    • Generalized Anxiety Disorder (GAD-7) scale for anxiety symptoms
    • Perceived Deficits Questionnaire – Depression (PDQ-5) for cognitive complaints;
      (alternate) British Columbia Cognitive Complaints Inventory (BC-CCI)
    • Sheehan Disability Scale (SDS) for functional disability
    • Lam Employment Absence and Productivity Scale (LEAPS) for work impairment
    • Frequency, Intensity, Burden of Side Effects Rating (FIBSER) for medication side effects.

For more information about scales that we have developed or revised (LEAPS, BC-CCI, PDQ-D, FIBSER), check our Rating Scales page.

The package of free scales and monitoring form that we use can be downloaded here.

Note that the SDS is licensed by Dr. David Sheehan and may have a cost for clinical use (inquire at eProvide).

How do I keep track of outcomes?

A simple monitoring form can help track scores over time. The one we use in the Mood Disorders Centre is available here.

Are there online tools for tracking outcomes for MBC?

Yes! Try out MoodFx.ca, our free easy-to-use web app (optimized for mobile devices) that allows patients to track their own outcomes. MoodFx uses these validated scales to allow screening and tracking of scores. Users can set reminders to complete the questionnaires and subscribe to weekly self-management tips via email or SMS. Available in English et Français! For more information, check our Overview of MoodFx and our MoodFx for Clinicians.

Watch a video of Dr. Lam talking about the usefulness of MBC

Dr. Lam’s Public talk on Workplace Depression and MoodFx

Slides from a public talk on workplace depression presented by Dr. Raymond Lam at the Mood Disorders Centre Clinical Day. Provides important facts about workplace depression and measurement-based care for depression.

Our peer-reviewed papers on MBC for depression:

Zhu M, Hong RH, Yang T, Yang X, Liu J, Murphy JK, Michalak EE, Wang Z, Yatham LN, Chen J, Lam RW. The efficacy of measurement-based care for depressive disorders: A systematic review and meta-analysis of randomized controlled trials. Journal of Clinical Psychiatry, in press, 2021.

Murphy JK, Michalak EE, Liu J, Colquhoun H, Burton H, Yang X, Yang T, Wang XR, Fei Y, He Y, Wang ZW, Xu Y, Zhang P, Su Y, Huang J, Huang L, Yang L, Lin X, Fang Y, Liu T, Lam RW*, Chen J* (*co-senior authors). Barriers and facilitators to implementing measurement-based care for depression in Shanghai, China: A situational analysis. BMC Psychiatry, in revision, 2021.

Hong RH, Murphy JK, Michalak EE, Chakrabarty T, Wang Z, Parikh SV, Culpepper L, Yatham LN, Lam RW*, Chen J* (*co-senior authors). Implementing measurement-based care for depression: Practical solutions for psychiatrists and primary care physicians. Neuropsychiatric Disease and Treatment 17:79-90, 2021.

Lam RW, Kennedy SH. STAR*D and measurement-based care: Don’t toss out the baby! Canadian Journal of Psychiatry 60:6-8, 2015.

Lam RW, Michalak EE, Swinson RP. Assessment Scales in Depression and Anxiety. [revised] London UK, Informa Healthcare, 2006, 194 pages. ISBN 10: 0-415-41495-4.